x

Read 1010-2b4cd753-2982-4b84-981a-fc24a05b0260.pdf text version

October 2010

At What Price is Procrastination?

Angela "Annie" Boynton, RHIT, CPC, CPC-H, CPC-P, CPC-I, CCS, CCS-P

2010 Salary Survey Inside

contents

[contents]

26 Features

12 Effective Collections in Hard Times

Kathy Philp, CPC

12

28

44

October 2010

In Every Issue

7 Letter from the President and CEO 8 Coding News 9 Letter from Member Leadership 10 Letters to the Editor

Education

Online Test Yourself ­ Earn 1 CEU go to www.aapc.com/resources/

ES CH A NG G COMIN JA N . 1

publications/coding-edge/archive.aspx

34 Prepare Yourself for the Certification Exam

Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC

14 Establish Practice-specific 1995 Detailed Examination Guidelines

Pam Brooks, CPC, PCS

37 Quick Tip: Fith-digit Not the Only Consideration for Septic Joint

Marcella Bucknam, CPC, CPC-H, CPC-P, CPC-I, CCC, COBGC, CCS, CCS-P

18 EHR Final Rules Set

G. John Verhovshek, MA, CPC

26 PQRI, E-prescribing, EHR Incentives, ICD-10 --Don't Wait!

Lynn S. Berry, PT, CPC

48 Chapters: Host Exams Before Year-end

Lynn Ring, CPC, CPC-I, CCS, CCS-P

28 Learn 5010 Lessons Early

Angela "Annie" Boynton, RHIT, CPC, CPC-H, CPC-P, CPC-I, CCS, CCS-P

People

38 Newly Credentialed Members 49 AAPCCA: Mentor Tomorrow's Chapter Leaders

Claire Bartkewicz, CPC-H

30 Salary Survey: Coding Still a Good Bet in Bumpy Seas

Robison Wells, MBA and Brad Ericson, CPC, COSC

42 Change With Our Coding Times

Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC

44 Vaccine Administration, Simplified

By G. John Verhovshek, MA, CPC

Coming Up

PQRI Physician Supervision Signature Requirements Catheter Placement Epidural Injections

www.aapc.com October 2010 3

46 Ochsner Health System Ventures a Coding Internship Program

George Dansker, MPH, MLIS, CPC-A

CPC-I, CCS, CCS-P, is painting here in Shrewsbury, Mass. Take advantage of incentive programs, otherwise procrastination could put your bottom line on the line. Cover photo by John Lenis Photography (www.photographybyjohn.com).

On the Cover: Don't paint the picture Angela "Annie" Boynton, BS, RHIT, CPC, CPC-H, CPC-P,

Serving 97,000 Members ­ Including You

Serving AAPC Members The membership of AAPC, and subsequently the readership of Coding Edge, is quite varied. To ensure we are providing education to each segment of our audience, in every issue we will publish at least one article on each of three levels: apprentice, professional and expert. The articles will be identified with a small bar denoting knowledge level:

APPRENTICE PROFESSIONAL

October 2010

Chairman

Reed E. Pew [email protected]

President and CEO

Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, COBGC, CPMA, CEMC, CPCD, CCS-P [email protected]

Beginning coding with common technologies, basic anatomy and physiology, and using standard code guidelines and regulations. More sophisticated issues including code sequencing, modifier use, and new technologies. Advanced anatomy and physiology, procedures and disorders for which codes or official rules do not exist, appeals, and payer specific variables.

Vice President of Marketing

Bevan Erickson [email protected]

EXPERT

Vice President, Business Development

Rhonda Buckholtz, CPC, CPC-I, CPMA, CGSC, CPEDC, COBGC, CENTC [email protected]

Directors, Pre-Certification Education and Exams

Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC [email protected] Katherine Abel, CPC, CPMA, CPC-I, CMRS [email protected]

advertising index

American Medical Association ............p. 17 www.amabookstore.com American Society of Health Informatics Managers ........................ p. 5 http://ashim.org The Coding Institute CodingCert.com ........................... p. 11 www.CodingCert.com Coding Conferences LLC www.CodingConferences.com CodingWebU ....................................... p. 50 www.CodingWebU.com Contexo Media ................................... p. 51 www.contexomedia.com HeathcareBusinessOffice LLC ........... p. 25 www.healthcareBusinessOffice.com Ingenix ................................................ p. 6 www.shopingenix.com Inhealthcare, LLC ............................... p. 16 www.supercoder.com Medicare Learning Network® (MLN) ..... p. 23

Official CMS Information for Medicare Fee-For-Service Providers

Vice President, Post Certification Education

David Maxwell, MBA [email protected]

Director of Editorial Development

John Verhovshek, MA, CPC [email protected]

Directors, Member Services

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

Senior Editors

Michelle A. Dick, BS [email protected] Renee Dustman, BS [email protected]

Production Artist

Tina M. Smith, AAS Graphics [email protected]

Advertising/Exhibiting Sales Manager

Jamie Zayach, BS [email protected]

Address all inquires, contributions and change of address notices to: Coding Edge PO Box 704004 Salt Lake City, UT 84170 (800) 626-CODE (2633)

© 2010 AAPC, Coding Edge. All rights reserved. Reproduction in whole or in part, in any form, without written permission from the AAPC is prohibited. Contributions are welcome. Coding Edge is a publication for members of the AAPC. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations. Current Procedural Terminology (CPT®) is copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. CPC®, CPC-H®, CPC-P®, and CIRCC® are registered trademarks of AAPC. Volume 21 Number 10 October 1, 2010

www.cms.gov/MLNGenInfo NAMAS/DoctorsManagement ............ p. 52 www.drsmgmt.com PMIC .................................................. p. 24 http://PmicOnline.com

Coding Edge (ISSN: 1941-5036) is published monthly by AAPC, 2480 South 3850 West, Suite B. Salt

Lake City, Utah, 84120, for its paid members. Periodical postage paid at the Salt Lake City mailing office and others. POSTMASTER: Send address changes to:

Coding Edge c/o AAPC, 2480 South 3850 West, Suite B, Salt Lake City, UT, 84120.

4

AAPC Coding Edge

letter from the president and CEO

Tap Into AAPC Resources

As the end of the year approaches, look to ways to prepare yourself for next year.

Plan for the Future of ICD-10

I love autumn, but it's right about this time when I begin to think about the fast approaching holiday season. There's so much to do and so little time. I know it will take a certain amount of preparation to ensure everything goes the way I envision it. The same holds true for the fast approaching ICD-10 implementation deadline. The time will come faster than anticipated, but timely preparation will ensure a rewarding experience. Code set training will come in 2012, but you should start preparing now because ICD-10 will change everything in your office. Develop a plan and follow it to keep you right on track to where you want to be in 2013. The good news is that AAPC has industry experts and market leading resources to put you ahead of the game. We are committed to providing the most current and comprehensive training available. We offer many free online resources, including articles, member discussion forums, and a code translator at www.aapc.com/ICD-10/ resources.aspx. AAPC will help you every step of the way to ensure all practices are prepared for what's to come.

medical coding profession and what the real financial benefits are for you. The survey is spotlighted on page 30 of this month's Coding Edge, and you can also view the full results and salary details on AAPC's website (www.aapc.com).

Find a Coding Job

Wondering where the coding jobs are? To make your job search easier, AAPC has compiled employer resources. We have upgraded our Job Center to provide you with more direct and accurate opportunities than ever before. This new online site (www. aapc.com/medical-coding-jobs/index.aspx) provides advanced searches to help you find the right opportunity.

Fully Benefit From All Three Resources

Review the 2010 Salary Survey and measure how you are doing compared to the market. If you are not where you want to be, take advantage of our Job Center and start looking at what is out there. Review the specialties AAPC offers and see if any are a good fit for you now or in your future plans. If you aren't already trained on ICD-10 implementation and don't understand the compliance and regulatory issues facing our industry, the time has come. You can access industry articles, news, and forum discussions on ICD-10 implementation through AAPC's website. Remember: Being prepared in all aspects of your coding career will ensure your future. Sincerely,

Compare 2010 Coding Salary Statistics

This month AAPC is excited to share the 2010 Salary Survey results. We are pleased that more than 10,000 medical coders responded to this year's survey. The high number of respondents makes the survey one of the most accurate and significant resources for coders to weigh career options. The survey answers questions about salary, including what specialties, certifications, locations, education, and other factors influence compensation. As a whole, the survey provides a better understanding of the

Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P AAPC President and CEO www.aapc.com October 2010 7

coding news

coding news

This enhancement relates to the following AR status codes:

HIGLAS AR Status Code HIGLAS AR Status Code Description

REQ-WRO-CO REQ-WRO-DJ REQ-WRO-RO REQ-WVR

Write-off requested-- at central office for approval Write-off requested--at Dept of Justice for approval Write-off requested--at regional office for approval Waiver requested

Change Request (CR) 7033 (www.cms.gov/ transmittals/downloads/R766OTN.pdf) is one of a series of communications issued by the Centers for Medicare & Medicaid Services (CMS) that pertains to system enhancements intended to reduce overpayments.

community mental health centers, and for all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness." "Claims with dates of service prior to July 1, 2007, should be routed through the nonintegrated versions of the OCE software (OPPS and non-OPPS OCEs) that coincide with the versions in effect for the date of service on the claim." Look for I/OCE specifications on the CMS website at www.cms.hhs.gov/OutpatientCodeEdit/.

CMS Expands HHA Claim Edits

Independent and provider-based home health agencies (HHAs) will soon need to be more diligent about certain information listed on claims when billing for services provided to Medicare beneficiaries. CMS has instructed regional home health intermediaries (RHHIs) to implement expanded edits beginning Jan. 1, 2011. CMS claim editing is expanding to verify that attending physicians listed on HHA claims are eligible for Medicare reimbursement. To prevent HHA claim denials, the attending physician should include on each HHA claim a valid National Provider Identifier (NPI), and that he or she is enrolled in Medicare and is either a doctor of medicine or osteopathy or a doctor of podiatric medicine. The expanded edits will be phased in over the next two years: Phase 1 (Oct. 1 - Dec. 31): RHHIs are instructed to issue a warning if the above requirements aren't met. Phase 2 (on/after Jan. 1, 2011): RHHIs are instructed to deny claims if the above requirements aren't met. Act now: Providers should verify their enrollment in Medicare's Internet-based Provider Enrollment, Chain and Ownership System (PECOS). Read revised MLN Matters article MM6856 (www.cms.gov/MLNMattersArticles/downloads/MM6856.pdf) for complete details.

NCCI Edits: Get 'Em While Hot

The quarterly updates to the National Correct Coding Initiative (NCCI) edits version 16.3, effective Oct. 1, are now available on the Centers for Medicare & Medicaid Services (CMS) Data Center (CDC). The NCCI promotes national correct coding methodologies to control improper coding that leads to incorrect payment in Part B claims. For information about NCCI, including the current correct coding and mutually exclusive code (MEC) edits, go to www.cms.gov/NationalCorrectCodInitEd on the CMS website. For additional information, see MLN Matters article MM7081 (www.cms.gov/MLNMattersArticles/ downloads/MM7081.pdf.

HIGLAS Enhancements Aimed to Eliminate Demand Letters

You no longer need to generate demand letters when accounts receivable (AR) transactions are requested for write-off or for waiver AR status code. Effective Oct. 1, transactions are ineligible for referral to treasury. Healthcare Integrated General Ledger Accounting System (HIGLAS) is changing the setup to stop AR overpayments from: Generating demand letters if any of the AR status codes listed below have been assigned to the AR invoice: (REQ-WROCO, REQ-WRO-DJ, REQ-WRO-RO, REQ-WVR). Appearing on the DCIA report if any of the AR status codes listed below have been assigned to the AR invoice: (REQWRO-CO, REQ-WRO-DJ, REQ-WRORO, REQ-WVR). 8 AAPC Coding Edge

I/OCE Streamlines Software Usage

Effective Oct. 1, the Integrated Outpatient Code Editor (I/OCE) is expanding its software usage to include non-Outpatient Prospective Payment System (OPPS) hospitals. This was designed to eliminate the need to update, install, and maintain two separate OCE software packages on a quarterly basis. In Change Request (CR) 7110 (www.cms. gov/transmittals/downloads/R2042CP.pdf), CMS lists I/OCE instructions and specifications to be used under the OPPS and nonOPPS "for hospital outpatient departments,

letter from member leadership

Four Governing Bodies Advise AAPC

growing business generally needs help dealing with unfamiliar issues that arise, and one of the best sources of help is an advisory board. AAPC is assisted by four governing boards: · National Advisory Board (NAB) · AAPC Chapter Association (AAPCCA) · Legal Advisory Board · Physicians Advisory Board These advisory boards are in place to make sure all AAPC bases are covered when a decision is made. To accurately represent all members of our organization and the coding issues we encounter, each governing body has a distinct role at AAPC.

A

NAB

The NAB works voluntarily with the national office to better membership and the medical coding community. It advises AAPC leadership on coding issues, trends, and member needs. Through active participation in nationally sponsored conferences, events, publications, and educational programs and activities, the NAB promotes AAPC's mission and the coding profession. NAB members share their coding expertise by writing articles and speaking at local chapters, national conferences, and other health care-related events. Each NAB representative is a spokesperson for the AAPC and its members. The NAB is comprised of 16 members appointed by AAPC who serve for a twoyear period. They represent eight geographical regions of the United States. There are four officers elected by the NAB including president, president-elect, member relations, and secretary, as well as a chairman and liaison who represent AAPC. For a list of current AAPC NAB members, go to: www.aapc.com/AboutUs/nationaladvisory-board.aspx.

ters and is comprised of 16 certified AAPC members, many of whom have former local chapter leadership experience, who work collaboratively with AAPC staff and current local chapter officers. The chapters are divided into eight regions with two representative board members each. Board members help create, maintain, and sustain chapter infrastructure, and help chapters when situations arise and chapter visits are requested. The board develops policies, by laws, and processes, and defines the roles of officers and committees. All board members have the opportunity to visit chapters, and speak on behalf of AAPC and the AAPCCA. AAPC members who have previously served as chapter officers are invited to apply to serve on the chapter association board of directors. To learn more about the AAPCCA, go to www.aapc.com/AboutUs/ local-chapter-board-of-directors.aspx.

Physician Advisory Board

Coding is a key part of practicing medicine. Without it, physicians would not get paid for their medical services. AAPC's Physician Advisory Board recognizes this. From a physician's perspective, they voluntarily advise AAPC leadership on coding issues and ensure AAPC members have all the tools they need to accomplish their jobs. To see a list of AAPC Physician Advisory Board members, go to: www.aapc.com/ AboutUs/physician-advisory.aspx.

Medical Coding Legal Advisory Committee

With increased health care regulations, quality measures, and government audits, some coders are confronted with legal issues and compliance questions on a daily basis. The Legal Advisory Board serves to advise the AAPC national office, the NAB, and the AAPCCA on legal issues associated with medical coding. They address members' compliance issues through member forums, authored articles, and national conferences. Legal Advisory Board members also sit on

AAPC's Ethics Committee and point out issues and legal points to consider. Legal Advisory Board members can be viewed at www.aapc.com/AboutUs/legal.aspx.

Upholding a Higher Standard

AAPC's governing bodies provide structured leadership and a strong foundation to support our membership's needs. We're here to serve you. Sincerely,

Chapter Assoc. Board of Dir.

The AAPCCA is an independent non-profit governing board for AAPC local chapters. AAPCCA assists more than 450 local chap-

Terrance C. Leone, CPC, CPC-P, CPC-I, CIRCC President, National Advisory Board www.aapc.com October 2010 9

letters to the editor

Letters to the Editor

Single Use Vials Are for a Single Patient

The article "Drug Waste = Money" (July 2010, pages 36-37) uses a clinical and coding example in which a provider treats three patients from a single, 100-unit vial of Botulinum Toxin Type A. As a nurse, I would never give different patients medication from a single-use vial. I checked with our hospital pharmacist and he agreed. Where did you find that more than one patient may be treated from a single-use vial? Kathryn R. Miller, RN, BSN, MS, CPC The example used in the article was adapted from the Medicare Claims Processing Manual (chapter 17, section 40). Here is the Medicare example: "A provider schedules three Medicare patients to receive Botulinum Toxin Type A on the same day within the designated shelf life of the product. Currently, Botox is available only in a 100unit size. Once Botox is reconstituted, it has a shelf life of only four hours. Often, a patient receives less than a 100 unit dose. The provider administers 30 units to each of the three patients. The remaining 10 units that must be discarded are billed to Medicare on the account of the last patient. Therefore, 30 units are billed on behalf of the first patient seen and 30 units are billed on behalf of the second patient seen. Forty units are billed on behalf of the last patient seen because the provider had to discard 10 units at that point." When "Drug Waste = Money" was written (March), the most current update for chapter 17, section 40 of the Claims Processing Manual was May 25, 2007 (as of publication, this version still may be referenced on the CMS website: http://cms. gov/transmittals/downloads/R1248CP.pdf). On April 30, CMS issued a revised section 40 (http://cms.gov/manuals/downloads/ clm104c17.pdf). This updated version, effective July 1, removes the example shown above and replaces it with the following: "For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units may be billed on another line by using the JW modifier. Both line items would be processed for payment." The revised section 40 no longer references treating multiple patients from a single-use vial. The manual does not specify that 10 AAPC Coding Edge it is inappropriate to divide a single-use vial among patients, but the removal of an example citing such use may acknowledge that the example is not clinically valid. Other providers we've talked to agree: It is not clinically appropriate to treat multiple patients from a single-use vial. Coding Edge

Does Endometrial Ablation Always Include Hysteroscopy?

"Maximize Coding for Minimally Invasive Ob/Gyn Surgeries" (September 2010, pages 34-35) advises reporting 58563, whether using Gynecare Thermachoice®, Novasure®, or Hydro ThermAblator® System for endometrial ablations. My providers rarely use hysteroscopic guidance when doing NovaSure® ablation. Is 58353 appropriate in this circumstance? Bridget Even, CPC Yes, 58353 Endometrial ablation, thermal, without hysteroscopic guidance is appropriate for endometrial ablation without hysteroscopy. The article specifies that 58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation and thermoablation) is appropriate for procedures that include hysteroscope. Kerin Draak, MS, RN, WHNP-BC, CPC, CEMC, COBGC

Photographer Correction

In the August issue, the image on page 30 with the caption "Home sleep diagnostic testing devices provide simple, costeffective, and reliable results" was photographed by Count Riddick (www.riddickphotography.com).

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

feature

Effective

Collections in

Hard Times

By Kathy Philp, CPC

Thoroughness and follow-through are essential to your practice's financial health.

C

ollections lie at the heart of a successful physician practice, and the first step to successful collections is dedicated, knowledgeable staff. As a consultant with 20 years of medical billing experience, the concept I instill is, "If the doctor doesn't get paid, neither does anyone else!" Staff must be aware of applicable state laws (and know when, for instance, to involve the insurance commissioner in a dispute), and must have a firm grasp of CPT®, ICD9-CM, and HCPCS Level II coding concepts. Additional basic concepts collections staff should be familiar with include: In-network vs. out-of-network: In-network means the practice has a contract with a particular insurance company. Out-of-network means the practice does not have a contract, and can collect the whole amount from the patient. (For more information on in-network vs. out-of-network, see "Make the Most of Out-of-Network Claims," Coding Edge January 2010, pages 18-19). Effective dates of insurance contracts: Services provided outside effective dates are out-of-network. Fee schedules: Hopefully, you have a system in place allowing you to load your fee schedule(s) and to compare contracted vs. actual payments. If actual payments don't equal contracted payments, contact the payer to find out why and make corrections. Adjustment (i.e., when and what to "write off "): A proper write-off occurs when you have a contract with the insurance company and the network the provider is in. But remember, just because the insurance company states to write-off a line item doesn't mean it is not collectable. Do your homework to determine if the write off is justified.

Silent preferred provider organizations (PPOs): These are becoming more common, and clinics are writing off adjustments unnecessarily as a result. Here's how silent PPOs happen: This form of PPO involves an arrangement (unknown to the provider) between the third-party payer and a PPO in which the provider is contracted. The contracted PPO sells its negotiated fee schedule to the patient's third-party payer, who then pays the provider based on the contracted rate. The non-PPO insurer may broker with many different PPOs, allowing for the non-PPO to utilize the fee schedule of any PPOs the provider has contracted. By doing so, the non-PPO will select the least expensive fee schedule to pay the claim. The insurer claims the discount through its contract with a discount "broker" or "vendor." If you can identify silent PPO activity is occurring and are able to calculate the financial impact on your organization, you may be able to bill the underpaid amount back to the PPO. The American Medical Association (AMA) believes silent PPO activity may be fraudulent, and if direct negotiations fail to recover payments, you may be justified to refer the problem to your state's insurance department.

APPRENTICE

Regular Reports Help You Track Success

Effective collections require regularly run reports. Depending on the software, you may run reports by the insurance company, and then by the physician. To work the reports (whether paper or electronic), sort them by insurance company so staff can work multiple claims with the same

12 AAPC Coding Edge

feature

The American Medical Association (AMA) believes silent PPO activity may be fraudulent, and if direct negotiations fail to recover payments, you may be justified to refer the problem to your state's insurance department.

insurer, saving repeated calls (if your system has a collection module, you won't have to run reports because you can work directly out of the system). There are many ways to work reports. No matter your approach, always work the oldest or highest amount claims first. Pay attention to secondary claims: Have they gone out in a timely manner? Who is working them? Your company goal should be 45-52 days maximum in accounts receivable (A/R), with collections at 70-85 percent of billed totals, depending on the percentage at which your fee schedule is set. Look at your benchmarks to see what is feasible in your office. Maximum practice reimbursement (MPR) is one important benchmark that aims to maintain optimum reimbursement while reducing the risk of an audit through proper coding and billing. The rule is, "If it was not documented, it did not exist." This is true from both legal and reimbursement standpoints. Don't forget to run rejections and/or error reports. If there are errors in your system when charges are filed electronically, and no one is working them, your A/R will be higher (that is, worse). Each system is different, and in some cases claims filed in error may stay in the 0-30 day bucket, and never get worked. This, too, will mess up your financial reports. Collection staff also must know how to work rejections from the clearinghouse. Management should review the reports and should sit down with the collections staff once a month to see how each insurance company is paying. This will allow you to identify areas of concern, such as an insurer with a higher balance or delayed claims payment. Know your state law that determines how quickly an insurance company must pay following submission of a clean claim. In some states, the requirement is 30 days, in other states it is 45 days, etc.

Educate Yourself, Be Persistent

When contacting an insurance company to find out claim status, understand that the insurer cannot tell the clinic/practice what modifier to add to get the claim to go through. Determining proper coding and documentation is the provider's/staff's responsibility. If the insurer states any claims are "in process," ask specifically if the claim is on the payment floor, and when it will be paid. Note every conversation with an insurer in the system. Document the time, day, and with whom staff spoke, as well as what the insurance company told them. Finally, if your system allows, give staff a "tickler" file to remind them to follow up. If your system doesn't accommodate such a function, create a spreadsheet to track claims and to remind staff to follow up (and follow through) within 10 days. The above are only the basics of collection. For many practices, the services of a consultant can be a worthwhile long-term investment. Consultants are there to help train staff and to offer expertise (and another set of eyes) in developing systems and processes. However you handle your collections, remember that thoroughness and followthrough are essential to the practice's financial health.

Kathy Philp, CPC, is well versed in compliance, coding, and billing for multi-specialties including facility and physicians.

www.aapc.com

October 2010

13

feature

Establish Practice-specific

1995 Detailed Examination Guidelines

By Pam Brooks, CPC, PCS

Standardize the ambiguous with this audit tool.

he question, "What constitutes a detailed examination in the 1995 Documentation Guidelines for Evaluation and Management Services?" conjures up ambiguous responses regarding evaluation and management (E/M) documentation criteria. For detail-oriented coders, this gray area is responsible for lengthy discussions, confusion, and occasional misinterpretation-- because there is no black-and-white answer. There are many ways for coding departments to clarify and to standardize "gray area" coding situations. One option is to establish practice-specific 1995 detailed examination guidelines. This will help external auditors assess documentation compliance and provide coding education to physicians. Besides providing a standardized audit tool, it ensures a consistent auditing process, regardless of coder interpretation and skill, which National Health Insurance Company (NHIC) acknowledges as an issue.

T

Evaluate Detailed Examination Guidance

The Centers for Medicare & Medicaid Services (CMS) and CPT® both describe the 1995 detailed examination as, "an extended examination of the affected body area(s) and other symptomatic or related organ system(s)." Contractors don't offer much additional explanation. Trailblazer explains the difference between the 1995 expanded problem focused exam and the detailed exam as, "the difference in the detail in which the 2-7 examined systems are described." Noridian, WPS, Palmetto, and National Government Services (NGS) follow CMS. NHIC is a bit more forthright and suggests: "The 1995 Guidelines are less precise. For example, they allow the physician (and the auditor) to choose their own definitions of `detailed' examination of an organ system. On audit, this vagueness often leads to differences of opinion--even among expert coders--on the appropriate level of examination on any given chart." 14 AAPC Coding Edge

NHIC is correct: Some coders will count 2-4 organ systems/body areas (OS/BA) to determine an expanded problem focused exam, while counting 5-7 OS/BA to satisfy a detailed exam. Other coders use the 1995 guidelines for all but the detailed exam, and rely on the "12 bullets in 6+ organ systems" criteria from the 1997 Documentation Guidelines for Evaluation and Management Services to support a detailed exam. Other coders rely on the 1997 guidelines entirely, to avoid the ambiguity of the 1995 guidelines. None of these are wrong, and there is no quick and easy answer, but it is a good idea to determine a method specific to your practice/specialty, and use it consistently to keep your auditing process compliant. Most coders and physicians prefer the 1995 guidelines because they tend to be "easier" for the physician to achieve. By using NHIC's suggestion to choose specifically your own definition of a "detailed" examination, you can develop practice-specific 1995 examination guidelines to clarify issues. This way, the internal auditing process is standardized, as is your creation of an audit tool specifically for the 1995 detailed exam.

PROFESSIONAL

Determine Criteria

Because the 1995 guidelines already indicate that 2-7 organ systems and/or body areas should be examined, this is the starting point for determining the "detailed" criteria. Ask yourself, "What constitutes a full examination within any one OS/BA?" When determining this, decide whether to list all possible bullets for each OS/BA, and consider a detailed examination as the documentation of 50 percent or more of these bullets. This would enable you to find a happy medium between the documentation of only two organ systems. This seems inadequate to support a detailed exam--and the documentation of 12 bullets in six OS--which frequently is difficult

feature

to achieve. To determine all examination options for each OS/BA, CMS' 1997 Documentation Guidelines for Evaluation and Management Services can be used to note every bullet item within each obtainable OS/BA (www. cms.gov/MLNProducts/Downloads/MASTER1.pdf). For instruction regarding examination methods and documentation, reference the medical student textbook Bates' Pocket Guide to Physical Examination and History Taking (Lippincott Williams & Wilkins, Philadelphia, 2007). This book is particularly helpful in explaining unfamiliar examination techniques to the non-clinician. Overall, it's important to identify those examination components used in both the general medical and specialty comprehensive exams. For example, the male genitourinary (GU) exam could include: GU Male Exam of scrotum Exam of penis Digital rectal exam of prostate gland Exam of urethra Exam of bladder If you keep with the proposed idea that a detailed examination includes documentation of 50 percent or more of the above bullets, then a detailed male GU examination would show, in a dictated note, performance of any three of the five bullets.

Look Into EMR Auditing Challenges

Many physicians now use an electronic medical record (EMR) to document their office and progress notes, which creates an entirely new auditing and documentation challenge. Most EMRs allow providers to select many additional examination bullets within the individual OS/BA templates, which are not necessarily the same as those published in the CMS 1997 guidelines. To determine additional options, you can set up a test patient within your EMR to undergo an examination and select every examination bullet. This allows a look at the actual office note language that would print to the medical note for every possible examination scenario. From this language, you can determine two things: 1. Whether the creation of practice-specific 1995 examination guidelines should include additional examination bullets; and 2. If the default EMR language would `fit' within the already-established 1997 bullets.

Many sophisticated EMR software packages are able to document examination bullets such as "Babinski reflex" and unfamiliar acronyms that may require additional research and coder/auditor training. The additional research and training is to identify the appropriate bullets and to familiarize coding staff with the rationale of these examination elements for medical necessity. The items listed in orange below indicate common EMRspecific language that most closely fits under the existing 1997 bullets for the male GU exam: GU Male Exam of scrotum hair distribution, epididymides, testes Exam of penis Digital rectal exam of prostate gland Exam of urethra Exam of bladder Some EMR language may show that another bullet in the integumentary system exam would be appropriate, as in this example: Integumentary Inspection of skin and subcutaneous tissue and nails Palpation of skin and subcutaneous tissue and nails inspection of hair distribution and quality When the number of possible bullets under each OS/ BA is determined, you can decide whether 50 percent or more of these bullets would indicate a detailed 1995 examination. Ask providers to weigh in on whether this "50 percent or better" approach is reasonable from a clinical, medically-necessary standpoint. A pulmonary specialist reviewed the five possible bullets for the respiratory examination below and determined that three of the five bullets were likely to be addressed in a detailed examination within his specialty. Respiratory 3/5 Inspection of chest with notation of symmetry and expansion tenderness Assessment of respiratory effort cough Percussion of chest Palpation of chest Auscultation of lungs

Implement and Evaluate the Audit Tool

When the draft audit tool of the 1995 detailed examinawww.aapc.com October 2010 15

feature

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

tion guidelines is complete, take time to get feedback regarding content and layout of the audit tool. Ask other coders to use this tool for their daily pre- and post-billing audits to determine usability and feasibility by implementing it with your standard E/M audit tool (specifically to validate the detailed examination). Pay attention to up/down coding when using the new exam audit tool. Query the physicians who have been identified systematically as not meeting the guidelines (due to the new tool's use) to decide if the new guidelines are too rigid, or if these physicians need help with documentation. Applying other guidelines during the tool's implementation is optional. You may decide not to count constitutional organ system as one of the systems qualifying for a detailed exam. For example, if the provider documents three or more vital signs, the overall appearance of the patient, and a cardiovascular exam only, the cardiovascular exam is required to meet the detailed criteria to support a detailed exam. Otherwise, an expanded-problem focused exam is warranted, even with the documentation

of a detailed constitutional exam. This prevents providers from documenting a detailed examination without addressing any of the organ system(s) affected in the history of present illness (HPI) and review of systems (ROS). It might make sense to mandate an expanded-problem focused exam to meet medical necessity; the documentation of a detailed examination must be within the organ system(s) related to the nature of the presenting problem. Multi-specialty practices should decide if there needs to be a single detailed 1995 examination guideline, or if a series of specialty-specific guidelines best serves the group. Regardless of which choice is made, the guideline usage should be constant so the physicians are audited on a level playing field.

Pam Brooks, CPC, PCS is physician services coding supervisor at Wentworth-Douglass Hospital, in Dover, N.H. She has a bachelor of science in Adult Education/ Workplace Training, from Granite State College (Concord, N.H.) and is enrolled in the MHA program at St. Joseph's College of Maine. She is experienced in billing, coding, and practice management and is secretary of the Seacoast-Dover, N.H. local chapter.

16 AAPC Coding Edge

Stay compliant in today's busy physician practice

Newly updated and revised, the third edition of Medical Record Auditor offers an in-depth discussion of how the medical record is structured and how to review medical record documentation to determine level of service. In addition to reviewing the documentation and coding guidelines used today, this resource provides chart-auditing fundamentals, case studies, and other helpful examples to guide and enhance your understanding. Designed to help navigate the important topic of record auditing, this book will assist the physician practice in maintaining compliance with the government, insurance carriers, and other agencies that review medical records. Tools are provided to aid in the proper audit of medical records, as well as instruction on analyzing and reporting results of an audit. Chapter exercises are included to test the reader's comprehension of the material, and include a new chapter and PowerPoint® presentation on regulatory guidance.

Available August 2010, softbound with CD-ROM, 8-1/2" x 11", 500 pages

Visit www.amabookstore.com for more information or call (800) 621-8335 to order!

hot topic

EHRnow to receiveRules Set Final incentive payments. Prepare

By G. John Verhovshek, MA, CPC

n July 13, the Centers for Medicare & Medicaid Services (CMS), in cooperation with the Office of the National Coordinator for Health Information Technology (ONC), released two final rules that together set the requirements for providers to achieve the goal of "meaningful use of certified EHR technology." By demonstrating this goal successfully, providers may earn incentive payments from Medicare and/or Medicaid, to offset the costs of adopting an electronic health record (EHR) system. Conversely, providers who do not meet "meaningful use" objectives by 2015 will face reduced Medicare payments.

O

CMS Defines Meaningful Use and Eligibility

For providers, the more anticipated of the two regulations released on July 13 was the EHR Incentive Program Final Rule (http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf), which details the definition and provider requirements for meaningful use of EHRs to qualify for incentives. Incentive payments are available from both the Medicare and Medicaid programs, but eligibility requirements differ between the two. For Medicare, an eligible professional (EP) is defined as a: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor As an EP, the provider must be "non hospital-based," or provide fewer than 90 percent of services in places of service (POS) 21 Inpatient hospital and/or 23 Emergency department. Hospital-based providers are not eligible for incentive payments under either the Medicare or Medicaid programs. Eligible hospitals under Medicare include: Subsection (d) hospitals that are: Paid under the inpatient prospective payment system (IPPS) Located in 50 states or the District of Columbia Critical access hospitals (CAHs) Medicare Advantage (MA) hospitals Medicaid requirements for EPs are more inclusive than those for Medicare. For Medicaid, an EP may be:

Doctor of medicine, osteopathy, dental surgery or dental medicine, podiatry, or optometry Chiropractor Nurse Nurse practitioner (NP) Certified nurse-midwife Dentist Physician Assistant (PA) in a federally-qualified health center (FQHC) or rural health clinic that is led by a PA To meet Medicaid requirements, an EP also must be nonhospital-based (fewer than 90 percent of services in POS 21 and 23) and must meet at least one of the following criteria: Have a minimum 30 percent Medicaid patient volume Have a minimum 20 percent Medicaid patient volume, and is a pediatrician Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30 percent patient volume attributable to needy individuals Eligible hospitals under Medicaid include: Acute care hospitals (including CAHS) with at least 10 percent Medicaid patient volume Childrens' hospitals (no Medicaid volume requirements) All eligible hospitals and Medicare EPs must have a National Provider Identifier (NPI) to participate in the EHR incentive program. Most providers also need to have an active user account in the National Plan and Provider Enumeration System (NPPES). CMS will use these systems' records to register EPs for the program and verify Medicare enrollment prior to making Medicare EHR incentive program payments.

PROFESSIONAL

Core and Menu Requirements Demonstrate Meaningful Use

The final rule requirements to demonstrate meaningful use of EHRs differ considerably than those proposed in January. For EPs there are 15 "core" requirements and five of 10 "menu" requirements that must be met. These menu requirements contain several population health-related objectives, and at least one of these must be chosen as one of the five menu requirements met.

18 AAPC Coding Edge

hot topic

With an estimated $27 billion in incentives to be paid out over the next decade, CMS has put its weight behind EHR adoption and use.

Eligible hospitals must meet 14 core requirements, and five of 10 menu requirements. According to a CMS press release announcing the final rule, this "two track" approach "ensures the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers' needs and their individual path to full EHR use." EPs and eligible hospitals share some common core and menu requirements, while other core and menu requirements are specific either to EPs or hospitals. For a list of core and menu requirements, visit the AAPC website at: http://news. aapc.com/index.php/2010/08/meaningful-use-core-and-menurequirements To qualify as meaningful use, the core and menu requirements must be reported in a minimum percentage of cases for which the requirement is measurable. For example, one of the core requirements is: "Maintain an up-to-date problem list of current and active diagnoses: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one entry, or an indication that no problems are known for the patient recorded as structured data." If the percentage of cases in which the requirement is met falls below the minimum (in this example, 80 percent), meaningful use is not demonstrated. CMS is taking a graduated approach to EHR implementation, and the final rule describes only the first of three stages, which begins in 2011. Stage 2 is set to begin in 2013. Both the number of requirements and the percentage of time those requirements must be met will increase in future stages, according to CMS. a.) Tobacco Use Assessment b.) Tobacco Cessation Intervention Adult Weight Screening and Follow-up If the provider is unable to report on one of these clinical measures because the provider sees no patients addressed by the measures, three alternate core requirements are available for reporting: Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old Childhood Immunization Status In addition to the three core (or alternate core) quality measures, an EP must report on any three additional CQMs, as selected from a list of 38 possible measures. For eligible hospitals, the final rule assigns 15 clinical quality measures, each of which must be met. For a list of core and menu CQMs for EPs and eligible hospitals, visit the AAPC website at: http://news.aapc.com/index. php/2010/08/new-clinical-quality-measures-for-2011 For 2011, reporting EHR core and menu requirements and clinical quality measures does not have to occur electronically because CMS doesn't feel the infrastructure is available at present to do this. Instead, the provider must "attest," using a secure mechanism, "to the type of certified EHR technology they are using and the results of their performance on all the measures associated with the reported objectives of meaningful use." CMS anticipates that by 2012 it will be able to receive reporting of clinical quality measures electronically, and will require electronic reporting for CQMs only at that time.

Exceptions Are Allowed

Under the final rule, EPs and eligible hospitals may be allowed an exception to individual reporting requirements or CQMs. If for one objective included in the menu set an EP attests that he or she did not have any patients or insufficient actions during the EHR reporting period on which to base a meaningful use objective measurement, the EP may be exempted from reporting on that measure. For instance, an EP would not be liable to report medication reconciliation (a core objective) if that EP was not on the receiving end of any transition of care during the EHR reporting period. www.aapc.com October 2010 19

Providers Must Report Clinical Quality Measures

A core requirement for both EPs and eligible hospitals is the reporting of clinical quality measures, or CQMs. Here again, the requirements for EPs and hospitals differ. To demonstrate meaningful use of an EHR, EPs must report on a total of six CQMs. Of these, three are core measures: Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair:

hot topic

If the provider is exempt from a particular requirement, that requirement no longer is considered when determining whether an EP, eligible hospital, or CAH is a meaningful EHR user. The final rule states, "If for one objective included in the menu set an EP attests that he or she did not have any patients or insufficient actions during the EHR reporting period on which to base a measurement of a meaningful use objective, rather than satisfy 5 of the 10 meaningful use objectives included in the menu set for EPs, the EP need only satisfy 4 of the 9 remaining meaningful use objectives included in the menu set for EPs."

or Medicaid) and the provider (EP or eligible hospital). For EPs, maximum incentives from Medicare are shown in Table A. EPs who predominantly furnish services in a geographic health professional shortage area (HPSA) may earn an additional 10 percent incentive over and above the aforementioned maximum payments, as shown in Table B.

Source: CMS (www.cms.gov/EHRIncentivePrograms/60_Medicare_Eligibile_ Professional.asp#TopOfPage) Resource: CMS publishes a list annually of geographic HPSAs at: www.cms.hhs.gov/HPSAPSAPhysicianBonuses/01_Overview.asp#TopOfPage

Incentives Are Based on Allowable Charges

EPs and eligible hospitals that demonstrate meaningful use of an EHR receive incentive payments equal to 75 percent of the U.S. Department of Health and Human Services (HHS) Secretary's estimate of charges for covered professional services furnished by the EP during the relevant payment year. The amounts are capped, and vary according to the payer (Medicare

Note that to earn the maximum total incentive ($44,000 over five years) an EP in the Medicare program must become a meaningful user of EHR no later than 2012. EP payments from Medicaid are slightly higher, and extend over a longer period, as shown in Table C. Each EP within a group practice may qualify for an individual incentive payment, but EPs may receive only a single EHR

Table A Medicare Incentives By Year Schedule

First Calendar Year for Incentive Payments

Calendar Year 2011 2012 2013 2014 2015 2016 Total Bonus Payment

2011 2012 2013 2014 2015

$18,000

$12,000 $18,000

$8,000 $12,000 $15,000

$4,000 $8,000 $12,000 $12,000

$2,000 $4,000 $8,000 $8,000 $0

$0 $2,000 $4,000 $4,000 $0

$44,000 $44,000 $39,000 $24,000 $0

Source: CMS (www.cms.gov/EHRIncentivePrograms/60_Medicare_Eligibile_Professional.asp#TopOfPage)

Table B First Calendar Year in which the EP receives an Incentive Payment

Calendar Year 2011 2012 2013 2014 2015 2016 Total 20 AAPC Coding Edge $4,400 CY 2011 $1,800 $1,200 $800 $400 $200 $1,800 $1,200 $800 $400 $200 $4,400 $1,500 $1,200 $800 $400 $3,900 $1,200 $800 $800 $2,400 $0 $0 $0 CY 2012 CY 2013 CY 2014 CY 2015 and later

hot topic

Table C: Medicaid Incentives By Year Schedule

Payment Amount for Year: First Year Medicaid EP Qualifies to Receive Payment 2011 First Year Medicaid EP Qualifies to Receive Payment 2012 First Year Medicaid EP Qualifies to Receive Payment 2013 First Year Medicaid EP Qualifies to Receive Payment 2014 First Year Medicaid EP Qualifies to Receive Payment 2015 First Year Medicaid EP Qualifies to Receive Payment 2016

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

TOTAL Possible Incentive Payments

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750

$21,250 $8,500 $8,500 $8,500 $8,500 $8,500

$63,750

incentive payment per year, regardless of the number of locations at which they practice. At the time of registration, an EP must choose to participate in either the Medicare or Medicaid program (not both). Incentive payments are made to the individual EP. An EP may switch between the programs one time after the first incentive payment is initiated. The CMS website (www.cms.gov/EHRIncentivePrograms/20_ Eligibility.asp#TopOfPage) provides the following summary of how the Medicare and Medicaid programs differ for EPs.

Medicare EHR Incentive Program

Can participate as soon as the federal program launches Can receive up to $44,000.00 in incentives, and up to $48,400.00 if practicing in a Health Provider Shortage Area

Medicaid EHR Incentive Program

Can participate once my state offers the program (check with your state for expected launch date) Can receive up to $63,750.00 in incentives Can qualify for payment for adopting, implementing, upgrading or demonstrating meaningful use of certified EHR technology in first participation year. Required to demonstrate meaningful use in each subsequent year to qualify for payment

Required to demonstrate meaningful use of certified EHR technology every year to qualify for payment

Whether an EP participates in the EHR incentive program may affect his or her eligibility for other incentive programs. For example, if an EP participates in the Medicare EHR incentive program, he or she may also be eligible for a physician quality reporting initiative (PQRI) incentive, as long as the EP meets requirements for both programs; however, an EP may not participate in the Medicare EHR incentive program and the e-prescribing initiative at the same time. For more information, visit the CMS website at: www.cms.gov/ MLNMattersArticles/downloads/MM6935.pdf Calculating possible incentive payments for hospitals is more complicated than for EPs. Essentially, hospitals begin with a base incentive of $2 million for demonstrating meaningful use, and the payment can rise from there. For Medicare, it pays to start early because the total incentives an eligible hospital can receive will decrease beginning in 2014. Eligible hospitals, unlike EPs, may receive incentive payments from both Medicare and Medicaid, as long as the hospital separately meets the eligibility requirements of both programs. Incentive payments are made to the facility (rather than to individual providers) by provider number in hospital cost reports.

Financial Penalties Begin in 2015

EPs and eligible hospitals that do not demonstrate meaningful use by 2015 will realize decreased Medicare payments. CMS states, "For 2015 and later, Medicare eligible professionals who do not successfully demonstrate meaningful use will have a payment reduction in their Medicare reimbursement. The payment reduction starts at 1 percent and increases up to 5 percent for every year that a Medicare eligible professional does not demonstrate meaningful use." www.aapc.com October 2010 21

Must participate by the second year to receive the maximum incentive payment

Must participate by 2016 to receive the maximum incentive payment

hot topic

Hospital-based physicians and Medicaid EPs are not subject to possible payment reductions, CMS clarifies; however, "if you are also a Medicare Fee-for-Service provider and cannot successfully demonstrate meaningful use, you will have a payment reduction in your Medicare reimbursement starting in 2015, even if you never received an incentive payment or only participate in the Medicaid EHR incentive program." Individual "hardship" exemptions to decreased payments may be granted on a case-by-case basis (for instance, for a rural practice without access to Internet connections, etc.)

Now Available: Technical Standards for Certified EHRs

The "Health Information Technology: Initial Set of Standards, Implementation, Specifications, and Certification Criteria for Electronic Health Record Technology" is the second of two final rules released July 13. In a nutshell, this 228-page final rule, developed by the National Coordinator for Health Information Technology (ONC), establishes the minimum required capabilities, and details the related standards and implementation specifications, for certified electronic health record (EHR) technology. As an example, to be "certified" an EHR system needs to allow the user to generate and transmit prescriptions and prescription-related information electronically, in accordance with specified standards. According to the final rule, "Complete EHRs and EHR Modules will be tested and certified according to adopted certification criteria to ensure that they have properly implemented adopted standards and implementation specifications and otherwise comply with the adopted certification criteria." The specifics of this rule are of primary interest to health information technology (HIT) companies and EHR systems vendors that are no doubt working in earnest to design EHR systems to meet certification requirements. For providers, the final rule provides piece of mind that any certified EHR system will have the technical capabilities necessary to allow the provider to demonstrate meaningful use. The provider's role is clear: Purchase and use an EHR system only if it has earned ONC certification. Systems that are not certified will not meet the criteria for meaningful use, and will not qualify the provider for Medicare and/or Medicaid incentive payments. The ONC will maintain on its website a Certified HIT Products List (CHPL) as a single, aggregate source of all certified complete EHRs and EHR modules. According to the ONC, "Eligible professionals and eligible hospitals that elect to use a combination of certified EHR Modules may also use the CHPL webpage to validate whether the EHR Modules they have selected satisfy all of the applicable certification criteria that are necessary to meet the definition of Certified EHR Technology." Additional resources: For a summary of certification issues, visit the CMS website at: www.cms.gov/EHRIncentivePrograms/30_ Certification.asp#TopOfPage. To read the Federal Register's Final Rule in full, go to: http://edocket.access.gpo.gov/2010/ pdf/2010-17207.pdf.

Time to Act

With an estimated $27 billion in incentives to be paid out over the next decade, CMS has put its weight behind EHR adoption and use. For interoperability and efficiency, EHRs are likely to become a necessity in the future--even for those providers who do not participate in Medicare or Medicaid. As a bonus for early adopters, the reporting period for 2011 is any continuous 90-day period for which the provider may earn the entire year's incentive. Beginning in 2012, the reporting period will be the entire year. For those providers looking to take the plunge, now's the time to act because the earlier you begin to demonstrate meaningful use, the greater your possible incentive payment.

[

G. John Verhovshek, MA, CPC, is director of editorial development/managing editor at AAPC.

]

Medicare Advantage Programs and EHRs

Under the Medicare Advantage (MA) program, electronic health record (EHR) incentive payments are made only to MA organizations licensed as health maintenance organizations (HMOs) (or in the same manner as HMOs by a state). The Centers for Medicare & Medicaid Services (CMS) website (www. cms.gov/EHRIncentivePrograms/85_Medicare%20Advantage. asp#TopOfPage) explains: "Medicare Advantage organizations are potentially entitled to EHR incentive payments by way of MA-affiliated hospitals (that is, hospitals that are under the same ownership and control as the Medicare Advantage organization) and Medicare Advantage eligible professionals. Medicare Advantage eligible professionals are individuals that are either: Employed by the Medicare Advantage organization, or Employed by a partner of the Medicare Advantage organization, where they furnish at least 80 percent of that entity's Medicare patient care services to enrollees of the MA organization. Medicare Advantage eligible professionals must furnish at least 80 percent of their Medicare-related professional services to enrollees of the MA organization and must furnish, on average, at least 20 hours per week of patient care services."

22 AAPC Coding Edge

"I Am Looking For Accurate Reimbursement Solutions."

R

Official CMS Information for Medicare Fee-For-Service Providers

The Medicare Learning Network® (MLN) is the destination for official Centers for Medicare & Medicaid Services (CMS) information for Medicare Fee-For-Service Providers. Get nationally consistent, accurate, timely and free information that will help providers correctly submit claims the first time. Please visit our website today.

http://www.cms.gov/MLNGenInfo

CODING &

COMPLIANCE

bO O ks, fO r M s A N d s O f t wA r E

2011

AAPC MEMBERS SAVE 25%­50% ON ALL PMIC PUBLICATIONS!

Order your 2011 coding and compliance books with PMIC by October 31st for a chance to win a brand new smart car.

It's

to order from PMIC.

1-800-MED-SHOP · PmicOnline.com

AAPC Code of Ethics

Members of AAPC shall be dedicated to providing the highest standard of professional coding and billing services to employers, clients, and patients. Professional and personal behavior of AAPC members must be exemplary.

z AAPC members shall maintain the highest standard

of personal and professional conduct. Members shall respect the rights of patients, clients, employers, and all other colleagues. professional dealings, and shall refuse to cooperate with, or condone by silence, the actions of those who engage in fraudulent, deceptive, or illegal acts. regulations of the land, and uphold the mission statement of the AAPC. education in all areas applicable to their profession. dignity, status, competence, and standards of coding for professional services. patients, employees, clients, or employers for personal gain.

z Members shall use only legal and ethical means in all

We're Proud of Our Expanding Chapters

New AAPC local chapters are popping up across the country to share the importance of coding excellence. Join us in welcoming the following new chapters:

z Members shall respect and adhere to the laws and

z Members shall pursue excellence through continuing z Members shall strive to maintain and enhance the

z Members shall not exploit professional relationships with

This code of ethical standards for members of the AAPC strives to promote and maintain the highest standard of professional service and conduct among its members. Adherence to these standards assures public confidence in the integrity and service of professional coders who are members of the AAPC. Failure to adhere to these standards, as determined by AAPC, will result in the loss of credentials and membership with AAPC.

Alexandria, Va. Arlington, Texas Aurora, Colo. Beaverton, Ore.

Grangeville, Idaho Murrieta, Calif. Scottsbluff, Neb.

Thanks to all who helped get them started!

If you or a colleague deserve kudos, please email [email protected]

Spend time w/ family and earn CEUs!

Need CEUs to renew your CPC®? Stay in town. Use our CD-ROM courses

anywhere, any time, any place. You won't have to travel, and you can even work at home.

· · · · ·

Finish at your own speed, quickly or leisurely Just 1 course earns as much as 18.0 CEUs Use any Windows® PC: home, office, laptop No Internet needed: no expiring passwords From the leading provider of interactive CD-ROM courses with preapproved CEUs

E/M Chart Auditing & Coding (16 CEUs)

Course on E/M Auditing! See our site. schedule ­ it's really your choice. So visit our Web site to learn more about CEUs, the convenient way! Our CD-ROM course line-up: E/M from A to Z (18 CEUs) Easily affordable with EasyPayments! Primary Care Primer (18 CEUs) www.HealthcareBusinessOffice.com/easypay.htm

(Most courses also have CEU approval from AHIMA. See our Web site.)

Finish a CD in just a few hours, or work around your

Demystifying the Modifiers (16 CEUs) Medical Coding Strategies (15 CEUs)

HealthcareBusinessOffice LLC: Toll free 800-515-3235 Email: [email protected]

Web site: www.HealthcareBusinessOffice.com

Continuing education. Any time. Any place.

www.aapc.com

October 2010

25

cover

In delay there lies no plenty.

-- William Shakespeare

PQRI, E-prescribing, EHR Incentives, ICD-10--Don't Wait!

Not taking advantage of incentive programs may put your bottom line on the line.

By Lynn S. Berry, PT, CPC

We all like to complain about government procrastination--but do we accept responsibility for our own shortcomings? Have you taken advantage of any of the government programs that could increase reimbursement in your practice or facility?

opportunities for utilizing registries and the EHR, and a new pilot group measure for fewer than 200 providers. Through 2014, there also is an additional 0.5 percent incentive for eligible professionals who satisfactorily participate in PQRI and who, more frequently than is required to qualify for or to maintain board certification status, participate in the maintenance of certification program (MOCP) and an MOCP practice assessment. From 2012-2014, the PQRI bonus incentive will decrease to 0.5 percent. For 2015, there will be a 1.5 percent penalty if you do not report. For 2016 and beyond, there will be a 2 percent penalty payment adjustment if you do not report. The Physician Compare website will include information on physicians enrolled in Medicare and professionals who participate in PQRI (presumably for 2010) by January 2011. Also for 2011, the names of eligible professionals and group practices who have reported quality measures satisfactorily for 2011 will be posted on the website. What will it look like to your patients if your practice is not on the list? Who will be their practitioner of choice? How will you respond? Will you continue to procrastinate, or will you get on board? For more information, go to www.cms.gov/PQRI.

E-prescribing

If you started (or will start) e-prescribing in 2010, you could receive an incentive bonus of 2 percent of allowed charges if you met the criteria of at least 25 events, with 10 percent of covered services made up of codes identified in the measure denominator. This could be by individual claims, registry, or EHR reporting. There also is a group practice measure option. You still could meet these criteria by reporting on measures this year, either on an independent e-prescribing system or within your EHR. What are you waiting for? For 2011, you could earn a 1 percent incentive bonus (unless you are receiving incentive from the EHR Incentive Program for 2011) by claims, qualified registry, or qualified EHR reporting. There also are proposed options for group practices (which are either the same as 2011), or for the pilot group option varying by size. Beginning in 2011, the Centers for Medicare & Medicaid Services (CMS) proposes to report publicly the names of eligible

PQRI

PROFESSIONAL

If you started (or will start) reporting on the physician quality reporting initiative (PQRI) in 2010, you could earn a 2 percent bonus on your total allowable Medicare charges for either a 12-month or six-month period. You have choices as to which measures fit your practice, which type of submission you choose (individual claims, registry, electronic health record (EHR), or the group option), whether you want to report individual measures or measures groups, and the time period for submission. For 2011, you still can earn a 1 percent bonus on your total allowable charges (and with less effort--the required number of claims for measures groups and the percentage of reporting for individual measures both have decreased). There also are more options (including 12 new measures and one new measures group), more

26 AAPC Coding Edge

cover

Things may come to those who wait, but only the things left by those who hustle.

-- Abraham Lincoln

professionals and group practices that are successful e-prescribers for the 2011 program. For 2012, the procrastinators may have an interesting problem. The penalty adjustment is retroactive to your performance in 2011. In 2012, you may be subject to a 1 percent payment adjustment unless during the Jan. 1, 2011-June 30, 2011 reporting period you: Report 10 unique e-prescribing events for patients in the denominator; Are not a physician, nurse practitioner (NP) or physician assistant (PA) as of June 30, 2011; or Do not have at least 100 cases containing an encounter code in the measure denominator. Even if you received the incentive in 2011, you must meet these criteria to avoid the penalty. Group practices must be successful e-prescribers during the 2011 reporting period and at least 10 percent of the professional of group's allowed charges must be based on codes in the denominator for the penalty to apply. If you are an office-based general practitioner or specialist who sees patients and regularly prescribes medications, you may be subject to this penalty and should act now to plan for 2011. Don't procrastinate anymore. Your bottom line will be affected if the proposed rule goes through as written. For more information, see www.cms.gov/eprescribing.

Nationwide Health Information Network. This could revolutionize medicine through: Efficiency Sharing of health information for care coordination Advancement of clinical processes with improved outcomes Data gathering regarding general population and public health issues For more information, see the article "EHR Final Rules: Prepare Now to Receive Incentive Payments" in this edition of Coding Edge.

HIPAA Version 2010, Version D.0, and ICD-10

HIPAA Version 2010 will go into effect on Jan. 1, 2012 for Version 5010 and D.0 electronic transactions, and ICD-10 for diagnoses will go into effect on Oct. 1, 2013. These standards will be the only means to transfer medical information electronically. If you are not ready, you will not be able to bill--not only for Medicare, but for other insurances as well. You will not be able to obtain claim status, check patient eligibility, receive your reimbursement notices, enroll in a health plan, or participate in coordination of benefits. AAPC has lobbied to put this off, but it is inevitable, and the timetable has been determined. Begin system implementation and put together a plan for staff training now! For each of these incentives or upcoming changes, it's natural to question whether getting on the bandwagon is worth the price. It will be in the long run. We will end up with evidence-based care, a value-based purchasing system, more patient safeguards, interconnectivity of information, more precise information, and more efficiency in our practices. For more information, see "Early Lessons Learned: 5010" and "Change With Our Coding Times" in this issue of Coding Edge.

Lynn Berry, PT, CPC, had over 35 years of clinical and management experience before beginning a new career as a coder and auditor and later a provider representative for a Medicare carrier. She now has her own consulting firm, LSB HealthCare Consultants, LLC, furnishing consulting and education to diverse provider types. She has held a variety of offices for her local AAPC chapter and continues as one of the directors of the St. Louis West Chapter.

EHR Incentive Program

Do you have an electronic medical record (EMR) that meets the meaningful use and certification criteria? Is there a price? Yes. Can you decrease your costs by acting sooner? Yes. EHR incentive plans include the Medicare Fee-for-Service Program, the Medicare Advantage Incentive Program, and the Medicaid Incentive Program, with total incentives for individual providers that could equal over $60,000. In 2015, Medicare penalties of 1 percent will begin for eligible providers who are not meaningful users of EHR technology. CMS envisions interconnectivity throughout the nation through a series of provider groups connected to a state Health Information Exchange Program or private health information exchanges that, in turn, connect to the

www.aapc.com

October 2010

27

cover sidebar

Learn 5010 Lessons Early

By Angela "Annie" Boynton, RHIT, CPC, CPC-H, CPC-P, CPC-I, CCS, CCS-P

It's big and the impact on your organization is uncertain until you begin.

T

he Jan. 1, 2012 deadline to adopt version 5010 transaction standards is approaching swiftly. The good news is: Organizations just uncovering the complexities associated with 5010 implementation can learn valuable lessons (like the following) from those who already are on their way to 5010 compliance. Lesson 1: There is no such thing as too much 5010/D.0/3.0 (or ICD-10-CM/PCS) communication. With over 800 unique changes to the current 4010 architecture, there is no such thing as too much information about 5010. The more informed internal and external customers are regarding the change, the lower the possibility for "the unexpected" later. Industry experts like AAPC, Workgroup for Electronic Data Interchange (WEDI), America's Health Insurance Plans (AHIP), and other industry organizations offer extensive training, and AAPC offers a number of free and low cost informative programs. Learn all you can and disseminate the information upstream and downstream within your organizations. Using currently available information is key to combat leaders who still believe there is "plenty of time" to begin implementation so communicate, communicate, and communicate! Lesson 2: Set clear definitions of Level 1 and Level 2 testing. The Centers for Medicare & Medicaid Services (CMS) has mandated Level 1 testing to begin in 2010 and Level 2 to begin in 2011. Level 1 tests 5010 transmission/receipt of claims data with internal partners, and it is most often referred to as internal testing. Level 2 testing consists of 5010 transmission/receipt with external partners, and it often is referred to as external testing. The government is clear in its expectation--so should your definitions and expectations be clear within your organization. Testing poses several communication issues where external trading partners need to be informed sooner, rather than later, about testing plans. Preparation is critical to the success of any testing. The better communication a trading partner has the more prepared they'll be. The ideal testing program tests transactions end-to-end: from filing to storage and at every point in between. If organizations only test areas they know will work, it is not considered testing. The goal of testing is to find areas of weakness or potential problems. No one wants to be involved in the aftermath

EXPERT

of a system breakdown, when testing should have identified the issue well in advance of the January 2012 compliance mandate. Jobs have been lost for less. Lesson 3: Expect the scope and impact of 5010/D.0/3.0 to be significant. This follows the English proverb, "Hope for the best, but plan for the worst." Much like National Provider Identifier (NPI), 4010A, and even the millennium bug (Y2K), such large scale projects almost always take longer and are broader in scope than we think they should be. Accepting this rule sooner than later will create less stress and produce more favorable outcomes. Lesson 4: There is never enough editing. For providers/facilities and payers who build their 5010 architecture internally, conducting an extensive review of field requirements is the best way to realize how 5010 changes will affect applications. You can never review or edit enough; consistently review content changes and edit design and programming.

28 AAPC Coding Edge

cover sidebar

This preliminary reviewing and editing will minimize the impact of 5010 implementation. Lesson 5: There is no such thing as too much vendor contact. Do not wait to contact your vendors, and do not solely rely on your vendors to implement your 5010 changes. If you wait until 2011, it is too late, and you risk your organization's compliance, and revenue. Work closely with system and software vendors to ensure timely delivery of complaint applications and early notification of compliance issues. A terrific method of keeping communication lines open with vendors is to periodically survey their 5010 (and ICD-10) readiness. With a few simple questions, you can gain a wealth of knowledge about vendor readiness. Here are sample vendor survey questions you can ask: Who is the testing contact person and what is his or her contact information? Who is the implementation contact person and what is his or her contact information? What is your 5010 readiness timeline? When will you begin trading partner testing? How can our organization participate in trading partner testing? Lesson 6: For overall implementation success, identify all responsible parties. Identifying work teams, project teams, and reasonable responsibility paths is imperative in any organization, regardless of size. In smaller organizations, this may be one or two people; in larger organizations this might mean dozens of people across many established business lines. Regardless of your organization's size, it's imperative that you set common goals and milestones and work together to achieve them. Identifying responsible parties also will help identify key crossover points, or junctions, where business processes may overlap. Dividing the responsibility and sharing information inevitably will allow your organization to conquer 5010 compliance. Lesson 7: It's never too soon to begin. This should be the official industry mantra. The scope of 5010/D.0/3.0 is massive: It's bigger than NPI, bigger than Y2K, and there is no way to ascertain the impact it will have on your organization until you begin. Start early. Better yet: Start now!

Annie Boynton is the director of 5010/ICD-10 communication/ adoption and training at UnitedHealth Group. She also teaches at Massachusetts Bay Community College and is a developer and member of AAPC's ICD-10 Curriculum Development Team.

www.aapc.com

October 2010

29

added edge

2010 SALARY SURVEY:

Coding Still a Good Bet in Bumpy Seas

By Robison Wells, MBA and Brad Ericson, CPC, COSC

Despite an unsettled economy, coding continues to float quite well.

hile coders aren't immune to the ups and downs of the bumpy economy, this year's salary survey indicates that being a credentialed coder has helped buffet the waves. Salaries of both credentialed and noncredentialed coders increased from previous years, according to results compiled from the on-line survey of more than 10,000 coders this summer.

W

How Much Are We Making?

Credentialed professionals saw a 1.5 percent increase in average salary to $45,404. Non-credentialed professionals also saw a 1.2 percent increase to an average salary of $37,746, maintaining a gap we have seen since it was first compared in 2000. Instructors with the CPC-I® enjoy the highest average salary at $69,207; these professionals, because of their experience and knowledge, are often in senior positions or work as consultants in addition to teaching.

30 AAPC Coding Edge

added edge

Years of experience obviously impact average salary and our findings this year show no exception.

Years of Experience

Overall Average Salaries

Average Salaries Year-by-year

$37,746 $44,740 $37,290

Years of Experience

1 2 3 4 5 6 7 8 9 10 15 20 25+

Certified

$34,551 $35,396 $37,096 $38,018 $40,638 $41,555 $41,931 $42,612 $42,335 $45,683 $50,307 $51,563 $53,669

Non-Certified

$30,175 $31,534 $32,180 $35,611 $39,638 $36,513 $41,875 $36,500 $34,853 $41,815 $46,633 $46,429 $47,805

d

f ie

Ce

r ti

2009

2008

$43,100 $36,500

$10K $20K $30K $40K $50K

No

n

Ce

r ti

f ie

2010

$45,404

d

Average Salaries by Primary Credential

Credential

CPC-A CPC

® ® ®

Our Education Level

The more education one has, the better the pay, just as in other careers. Regardless of the level of education, holding coding certification still provides more pay. However, it appears that education level doesn't dramatically impact a coder's salary until that coder achieves a bachelor's degree. Note the $10,000 difference between having a high school diploma and having a bachelor's degree. In addition, the number of respondents with an associates or bachelor's degree increased this year while the number of coders whose education ended with a high school diploma decreased.

All

$33,033 $45,347 $51,768 $56,031 $69,207 $50,278 $48,841 $54,667 $58,485 $56,888 $50,698 $40,962 $48,246 $47,083 $55,119 $52,105

Job Title: Coder

$32,792 $39,953 $42,930 $45,750 $50,543 $41,591 $41,574 $40,250 $50,000 $45,000 $42,500 $35,357 $43,690 $41,912 $45,595 $42,937

CPC-H CPC-P CPC-I CASCC

®

® TM

CANPCTM CCCTM CEDCTM CEMCTM CGSCTM CHONC COBGC COSC CIRCC CPMA

TM TM

Salary by Last Education Achieved

Certified

Some High School High School Technical School Some College Associate's Degree Bachelor's Degree Master's Degree Doctorate Degree $39,167 $41,272 $41,017 $45,038 $43,868 $51,389 $64,807 $74,205

Non-Certified

$27,500 $36,764 $33,413 $36,409 $35,807 $47,421 $50,929 $62,500

TM ®

TM

www.aapc.com

October 2010

31

added edge

What is the highest level of education you have completed?

Some college 36.7% Associate's degree 19.6% Some college 36.7% Associate's degree 19.3% Bachelor's degree 14.1%

2010

2009

Technical school 13.6% High school graduate 12.5%

Where We Work

As in previous years' surveys, payers, hospitals, and large facilities or practices pay certified coders more. Average Salary by Job Definition

Technical school 13.4% High school graduate 11.6% Some high school 0.3%

Bachelor's degree 15.3%

Master's degree and higher 2.9%

Some high school 0.4%

Master's degree and higher 3.1%

Average Salary by Workplace

Certified Avg Salary

Manager: Office Staff Educator Auditor Consulting Product Development Clinical $53,707 $39,103 $53,733 $49,708 $78,026 $70,000 $60,321

Non-Certified Avg Salary

$46,408 $32,944 $40,395 $45,000 $58,636 $47,500 $44,833

All Certified

Solo Small Medium Large Payer ASC Other Outpatient Hospital (Outpatient) Hospital (Inpatient) Home Health Long Term Care $40,430 $42,043 $41,985 $45,480 $54,100 $43,509 $41,242 $45,005 $47,848 $37,965 $39,881

All Non-Certified

$35,990 $37,910 $33,780 $39,682 $48,750 $46,250 $33,306 $37,206 $37,644 $24,167 $37,500

Geographic Differences

How do you fare compared to the average reported salary in your state? We've broken the average down below using the United States government's Census Bureau's breakdown of four major regions with nine sub regions. The Pacific subregion--made up of Alaska, Hawaii, Washington, Oregon, and California--continues to have the highest average salary while the East South Central subregion--made up of Kentucky, Tennessee, Mississippi, and Alabama--has the lowest average salary. California, Maryland, New Jersey, and Massachusetts have the highest salaries.

This map key details the regions and their average salaries

New England ­ $46,574 Mid Atlantic ­ $46,690 East North Central ­ $41,431 West North Central ­ $40,897 South Atlantic­ $42,565 East South Central ­ $39,626 West South Central ­ $42,078 Mountain ­ $44,617 Pacific ­ $51,428

32 AAPC Coding Edge

added edge

Average Salary by State and Region

Northeast Maine New Hampshire Vermont Massachusetts Rhode Island Connecticut New York Pennsylvania New Jersey $46,643 $39,953 $43,322 $44,123 $51,159 $47,353 $48,506 $46,596 $43,944 $53,725 Midwest Wisconsin Michigan Illinois Indiana Ohio Missouri North Dakota South Dakota Nebraska Kansas Minnesota Iowa $41,235 $42,993 $40,347 $42,298 $40,845 $40,890 $40,637 $4 0,240 $39,136 $41,775 $38,845 $46,021 $38,316

South Delaware Maryland DC Virginia West Virginia North Carolina South Carolina Georgia Florida Kentucky Tennessee Mississippi Alabama Oklahoma Texas Arkansas Louisiana

$41,863 $48,269 $54,133 $50,625 $41,392 $38,380 $41,285 $41,596 $42,906 $41,483 $37,430 $41,598 $37,576 $39,500 $39,485 $44,319 $36,856 $41,080 West Idaho Montana Wyoming Nevada Utah Colorado Arizona New Mexico Alaska Washington Oregon California Hawaii $48,150 $41,675 $38,500 $37,870 $44,386 $42,083 $48,333 $45,303 $46,250 $51,447 $48,941 $43,589 $55,164 $51,071

Work and Working

In a year of continued choppy economic seas, credentialed coders continue to do well. At press time, the U.S. Bureau of Labor Statistics says 9.6 percent of the country's workforce is unemployed, higher than in previous salary survey periods, yet coders have a lower rate of unemployment. Here is a breakdown of survey respondents' experience in the last year. When respondents who had started a new job in the last year were asked how they found their job, 38 percent said through networking.

There are some things in our survey that indicate few changes from last year. Respondents who worked an average of 31-40 hours per week amounted to 58 percent, compared with 38 percent, who work 41 to 71 hours per week. More than 91 percent of you receive health insurance, 89 percent receive paid sick time, and 78 percent receive dental insurance as benefits, and over half of you find these benefits partially paid by your employer. Respondents reported a majority have some part of the decisionmaking role in their workplaces. Eighteen percent are ultimately responsible for some or all business decisions and 37 percent have input but don't have decision making authority. The contribution of 55 percent of coders in decision-making underlines the contribution coders are making in our workplaces. Sixty-eight percent say their practices conduct chart audits and 58 percent of those do them quarterly. Nearly a quarter of respondents are in workplaces that have already started to prepare for ICD-10 implementation in October 2013. Sample size was 10,306 and margin of error is plus or minus 1.2%. More information can be found on AAPC's website www.aapc.com.

Robison Wells received his MBA from the Marriott School of Management at Brigham Young University. He has written articles for many newspapers, magazines, and webzines, and is senior marketing specialist at AAPC.

Average months unemployed

CPC

®

6.8% 5.6%

5.4 4.5

CPC-I

percent of total respondents

percent unemployed during the last 12 months

Credentials

90% 7%

®

[

Brad Ericson, CPC, COSC, is director of membership and publishing at AAPC.

]

October 2010 33

www.aapc.com

added edge

Get insider exam tips from a test-taking expert.

By Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC

Prepare Yourself for the Certification Exam

O

APPRENTICE

ver the years I have gathered great tips to prepare for and to successfully take AAPC's certification exams. First and foremost, you must undertake a complete and thorough study of the subject's material for the exam. Above and beyond that, there are several things you can do to prepare for exam day.

remember these specific definitions and not need to look them up while taking the exam, there may be other instructions that could be located more quickly if labeled.

Mark Up Your Books

Highlight any parenthetical notes under the codes in your CPT® book that might affect the answers you select. For example, if you are answering a question regarding anesthesia for a procedure on the larynx of a 3-month-old child (00326 Anesthesia for all procedures on the larynx and trachea in children younger than 1 year or age), be aware that the parenthetical note following the code indicates, "Do not report 00326 in conjunction with 99100." If you do not see this note, you may select an inaccurate answer that includes 99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure). If any sections of the CPT® book are particularly difficult for you, develop a system for marking your book to highlight the differences between codes. For example, if you want to do this for the 10040-10180 series (Incision and Drainage in the Integumentary System), you could use the following method of circling and underlining: 10040 Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single 10061 complicated or multiple 10080 Incision and drainage of pilonidal cyst; simple 10081 complicated 10120 Incision and removal of foreign body, subcutaneous tissues; simple 10121 complicated 10140 Incision and drainage of hematoma, seroma or fluid collection 10160 Puncture aspiration of abscess, hematoma, bulla or cyst

Review Guidelines and Intros

Review the coding guidelines in the front of the ICD-9-CM book. The guidelines contain great general information on diagnosis coding and chapter-specific coding information. Also review the guidelines for each section of the CPT® book and, within each section, all introductory paragraphs for each subsection. The guidelines and introductory paragraphs provide invaluable information required for accurate coding. Be sure you understand and can apply everything in these sections.

Label Material for Quick Look-up

Consider labeling paragraphs for any topics or instructions you want to find quickly during the test. For example, the Evaluation and Management (E/M) Services Guidelines contain the following: "New and Established Patient Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." If you label the first paragraph "New Patient" and the second paragraph "Established Patient," you will quickly find these definitions if you need them. While you might 34 AAPC Coding Edge

added edge

If you notice the exact same code in all four options, do not take time to evaluate that code since it will not influence the answer you select.

10180 Incision and drainage, complex, postoperative

wound infection All of the codes in this subsection deal with incision and drainage. The circled words highlight the difference between the codes, and the underlined words indicate variations of those differences. Using a method like this should increase your accuracy and speed when selecting codes.

Take Advantage of Practice Exams

Prior to taking the CPC® exam, purchase at least one of the three practice tests available on AAPC's website. These are essential in helping determine whether you have mastered the material. They also give you a preview of what the actual exam is like.

Master Multiple-choice Questions

Since all of AAPC's certification exams are multiple choice, you would be wise to develop a strategy for answering this question format efficiently. The exams are timed and your strategy must allow for quick and accurate code selection. I suggest you underline or circle key words in the question as you read and focus on the last sentence. This will help you determine what should be coded and will lead to more accurate code selection. Do not read the question and begin searching for the codes in your books. Instead, focus on the answer options and go directly to those codes and look them up. This will allow you to quickly determine which answer is correct. Many of the answers have multiple codes that must be evaluated for each option. For example, each potential answer (a through d) might have three codes. If you are particularly knowledgeable in one area, focus on the codes from that area first to eliminate options that you know are wrong. If you notice the exact same code in all four options, do not take time to evaluate that code since it will not influence the answer you select. This will allow you to quickly focus on the remaining alternatives. Some of the exam questions may include an operative (op) report you must evaluate to determine the answer. Most op reports include information that will not impact your code selection. Quickly skim any unneeded information (e.g., "The patient was prepped and draped in sterile fashion.") and focus on the surgical approach and definitive procedure described in the report.

ave a guaranteed method of waking up. You do H not want to miss the exam because you overslept. If you need to, set two alarms or ask someone to call you to be sure you are up on time. onfirm the location of the exam before the exam C day. If you have never been to that location before, drive there a few days before the exam to guarantee you can find the building and parking on the day of the test. repare snacks and a drink to take with you to P the exam. Since the certification exams last five hours and 40 minutes, you are likely to be thirsty and hungry before the time ends. When selecting snacks, consider your fellow examinees and do not choose loud and crunchy or smelly food.

Pay Attention to Instructions

Before your examination day, be sure to check the Frequently Asked Questions (FAQs) on www.aapc.com. Please make sure you remember to bring the permissible books to the exam. Read along with the proctor as he or she reads your instructions. And, be particularly sure you fill in the demographics part of the test grid completely and accurately as instructed.

Keep Track of Time and Answers

As you take the exam, watch your time. Completing a certification exam often requires the entire time allotted. Sit in a location where a clock is visible or wear a watch. As you answer the questions, circle your answer in the test booklet and then bubble the answer on the answer sheet. This is a timesaver if you miss a question or if you don't fill in a bubble. For example, when I took the CPC® exam, I lost track of my place and realized I had not bubbled in at least one of my answers on the answer sheet. Because I had marked the answers in my test booklet, I quickly determined where my bubbling got off track. Last but not least, select an answer for every question on the exam. If you run out of time and think you might not complete the exam, quickly scan the remaining questions and select the most likely answers in the time you have left. If you leave an answer blank, it is counted as an error. Good luck with your exams.

Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC, is a senior compliance specialist with Carolinas Healthcare System. She has over 20 years of experience in the health care industry and is the immediate past president of the Charlotte, N.C. Chapter of AAPC. Nancy was recently named AAPC's 2009 Coder of the Year. She can be reached at [email protected]

Simplify Your Exam Experience

When preparing for the actual exam day, there are several things you can do to avoid problems and make your exam experience easier.

www.aapc.com

October 2010

35

quick tip

Quick Tip

"The answer is both simpler and more difficult than it seems. First, the simple part: The elbow belongs in the upper arm. The knee belongs in the lower leg. This information is available as a note at the beginning of chapter 13, `Musculoskeletal System and Connective Tissue,' of ICD-9-CM. Therefore, for confirmed pyogenic arthritis of the elbow, the correct code would be 711.02. For confirmed pyogenic arthritis of the knee, 711.06 would be correct. The more difficult part: I would not code a septic joint as pyogenic arthritis without more information. Most septic joint diagnoses I've come across were actually septic because the patient has had a joint replacement (or other joint implant). This would be coded as a complication of an implant (996.66

Infection or inflammatory reaction due to internal joint prosthesis) with a V code for the joint replacement."

Fifth-digit Isn't the Only Consideration for Septic Joint

Linda Lightner-Griffith, CPC, asks Coding Edge this question:

"What is the correct way to code the fifth digit for a septic joint? Specifically: the knee or elbow. There is a lot of confusion on this point. I have asked several other certified coders and I get conflicting answers. Should septic elbow be 711.02 Pyogenic arthritis upper arm, 711.03 Pyogenic arthritis forearm or 711.08 Pyogenic arthritis other specified site? What about septic knee: 711.06 Pyogenic arthritis lower leg or 711.08?"

Marcella Bucknam, CPC, CPC-H, CPC-P, CPC-I, CCC, COBGC, CCS, CCS-P, manager of compliance education for a

large university practice group, long-time consulting editor for

General Surgery Coding Alert newsletter, and a presenter at

five AAPC National Conferences replies:

Call 1-800-626-2633 to register today!

MAKING

SENSE OF

MAC E/M RULES

Have you ever struggled with the gray areas of E/M Guidelines for code selection? Have you ever struggled to find the answer from the CMS website? Join us for Making Sense of MAC E/M Rules to learn helpful hints and tips for accurately coding E/M.

october workshop

AAPC's October Workshop | 6 CEUs | 3-Hours | Your City

You'll learn to

- Compare and contrast the 1995 and 1997 Guidelines - Identify documentation requirements for your MAC - Identify compliance hot spots and how do to avoid them - Use E/M modifiers with confidence - Navigate the CMS site to find the right answers

www.aapc.com/macrules

www.aapc.com October 2010 37

newly credentialed members

newly credentialed members

Deborah L David, CPC, CPMA APO AE Felicity Glover-Bell, CPC Birmingham AE Joan Raper, CPC Houston AE Rita Chauncey, CPC Anniston AL Bethany Ann Kelly, CPC Anniston AL Lynn LeBaron, CPC Cottondale AL Janet Carswell, CPC Hazel Green AL Gloria Ann Taylor, CPC Madison AL Valerie Brock, CPC Muscle Shoals AL Shirley Weatherford, CPC Union Grove AL Sara Michelle Wawak, CPC Alexander AR Sandra Lee Dorrell, CPC Benton AR Julia Nicole Harris, CPC Bigelow AR Ashley Dawn Bryant, CPC Center Ridge AR Rhonda Faye Roetzel, CPC Conway AR Elisa "Lisa" Marie Reed, CPC Little Rock AR Suzanne Collums, CPC Sheridan AR Nikki Thompson, CPC Sherwood AR Deanna Blake, CPC Apache Junction AZ Bernadette Rish, CPC Bullhead City AZ Amanda Sorge, CPC-H Cave Creek AZ Nicole Woodruff, CPC Flagstaff AZ Tina Gaydosh, CPC Green Valley AZ Julie J Tsethlikai, CPC Green Valley AZ Janet L Clark, CPC Mesa AZ Michael Brent Harbin, CPC Pelham AZ Sandra Poquette, CPC, CPC-H Peoria AZ Julia E Huston, CPC, CPC-H Phoenix AZ Linda Myrick, CPC Phoenix AZ Sandra Osborn, CPC Phoenix AZ Rhonda Zollars, CPC, CPC-H Phoenix AZ LeeAnn Southall, CPC, CIRCC, CCC, CGSC Prescott Valley AZ Susie Kottkamp, CPC Scottsdale AZ Martha Kozak, CPC Scottsdale AZ Kristyn Bova, CPC, CPMA, COBGC Tucson AZ Jessica V Coats, CPC Tucson AZ Jennifer Henry, CPC Tucson AZ Jack Matthew Jordan, CPC Tucson AZ Michelle Nichole Martin, CPC Tucson AZ Jamie Dyan Martinez, CPC Tucson AZ Jesse R Radley, CPC Tucson AZ Catherine J Smith, CPC Tucson AZ Monique Janei Ybarra, CPC Tucson AZ Stephanie Poolheco, CPC Winslow AZ Reana Reynoso, CPC Anaheim CA Brian Proosow, CPC Antioch CA Cheri Lorae Witcher, CPC Berkeley CA Michael Silva, CPC Camino CA Karen Beard, CPC El Cajon CA Kristina Zamora, CPC Fremont CA Susan Andresen, CPC Fresno CA Kristine Nelson, CPC Fresno CA Lori Rivera, CPC Gilroy CA Maria Armina Aguas, CPC Granada Hill CA Karen Siegiel, CPC, CPC-H La Mesa CA Jerri Clarke, CPC La Mirada CA Michelle R Browhaw, CPC Los Angeles CA Alice Torres-Garcia, CPC Mission Hills CA Marianne Lester, CPC-H Monterey CA Jeanne Jo Nutting, CPC, CPMA Oceanside CA Fred Ruddeck, CPC Oceanside CA Josseline Picar, CPC-H Ontario CA Adele Marie Davis French, CPC Placerville CA Liza Enriquez, CPC Rancho Santa Margarita CA Marcia Bean-Ebersole, CPC San Diego CA Helen Louise Deal, CPC San Diego CA Carol Ann Stoyla, CPC San Diego CA Gary L Chan,, CPC, CPMA San Francisco CA Anita Delucio, CPC Santa Clarita CA Carol Stoller Novak, CPC Simi Valley CA Glenda C Flancer, CPC Stevenson Ranch CA Charles A Fisher, CPC, CPMA Sunnyvale CA Ana G Johnson, CPC Sylmar CA Elizabeth Akopyan, CPC Van Nuys CA Tina Coleman, CPC, CPMA Aurora CO Georgette P Vasquez, CPC Eagle CO Rachel L Mondragon-Gonzales, CPC Gypsum CO Shanon Giffin, CPC, CPMA Leadville CO Denise Irene Etl, CPC, CPC-P Longmont CO Sally J Sjobeck, CPC Parker CO Dianne L Munger, CPC Derby CT Carol Lynn Cunningham, CPC Ellington CT Stacey L Page, CPC Ellington CT Lindsay Allison Gauthier, CPC Manchester CT Gabrielle Gessica Gilbert, CPC Manchester CT Sherry K Sittnick, CPC Manchester CT Anita J Verlotta, CPC Manchester CT Karen Yacone, CPC Manchester CT Nancy Gaspar, CPC Mansfield CT Caroline C O'Brien, CPC Northford CT Madelyn Marquez, CPC Norwalk CT Sharon Poli, CPC Norwalk CT Cathy Garguilo, CPC Seymour CT Joan P Warga, CPC Shelton CT Gwyn S Wilson, CPC Shelton CT Donna Rose Hanish, CPC Stratford CT Melissa Noel Roman, CPC Torrington CT Catherine Ruth Ruiz, CPC Trunbull CT Andrea M Carty, CPC Vernon CT Debbie Ann Girard, CPC Vernon CT Melissa White, CPC Vernon CT Amy Hudyma, CPC Wethersfield CT Samantha Nicole McDonald, CPC Washington DC Amy Patton, CPC Newark DE Wanda Carlton, CPC Apopka FL Jody Harrison, CPC Auburndale FL Lynn A Stuckert, CPC, CPMA Cape Coral FL Emmeline L. Johnson-Greimel, CPC, CPMA Cocoa FL Sharleia White-Oxendine, CPC Daytona Beach FL Sandra Zavala, CPC DeBary FL Katie Allen, CPC Deltona FL Eva Zavala, CPC Deltona FL Diane Eliason, CPC Destin FL Gianni Gonzalez, CPC, CPMA Fleming Island FL Marilyn Kay Lawrence, CIRCC Ft Myers FL Mindy Ellen Pendarvis, CIRCC Ft Myers FL Shalan RheAnn Walker, CPC Glen St Mary FL Arle Fernandez, CPC Hialeah FL Mary Smallwood, CPC Inverness FL Tanya Lloyd, CPC Jacksonville FL Shadwick D'wayne London, CPC Jacksonville FL Felicia Owens, CPC Jacksonville FL Theresa Pariseau, CPC Jacksonville FL Noretta Rasmussen, CPC Jacksonville FL Olivia E John, CPC Land O'Lakes FL Maria M Alemany, CPC Miami FL Ana Cecilia Fonseca, CPC Miami FL Ana Lunn, CPC Miami FL Mabiet Villegas, CPC Miami FL Tracy P Durstine, CPC Newberry FL Jamie Biondo, CPC Orange Park FL Raquel Marrero, CPC Orlando FL Jennifer M Flynn, CPC Panama City FL Rosario Paulino, CPC Pembroke Pines FL Shirley Piland, CPC Pensacola FL Melissa Rogers, CPC Pompano Beach FL Jean Margaret Leone, CPC Ponte Verda Beach FL Kathleen Andrews, CPC, CPC-P Sarasota FL Donna Rogers, CPC Spring Hill FL Mary Bray, CPC St Petersburg FL Nicole Lynn Davis, CPC St Petersburg FL Christine Hancock, CPC St Petersburg FL Lillian Lawrence, CPC St Augustine FL Kiosha Forston, CPC Tallahassee FL Javier Mercado, CPC-H Tamarac FL Aline J Coffee, CPC Tampa FL Mary Warfel, CPC Tampa FL Dalania L Carson, CPC, CPC-H Valrico FL Doris Rodriguez, CPC Winter Springs FL Mendy Slappey, CPC Albany GA Sharon Allard, CPC Atlanta GA Seema Mohamedy, CPC, CPMA Covington GA Cathy Staples-Bowden, CPC, CPMA Covington GA Candace Duncan, CPC Evans GA Amanda Edison, CPC Hampton GA Virginia Tinkey, CPC Lawrenceville GA Kelisha Lopez, CPC Monroe GA Faye G Grile, CPC, CPMA, CEMC Pooler GA Candace K Kraus, CPC, CPC-P Savannah GA Deborah Yvette Mathis, CPC Stone Mountain GA Megan D Mierswa, CPC Watkinsville GA Annaliza G Daquioag, CPC Honolulu HI Jamie L Hamilton, CIRCC Ames IA Katie Roemer, CPC Davenport IA Janeen Hipple, CPC Solon IA Michelle Cirino, CPC Boise ID Denise Delaney, CPC Buhl ID Samantha Smith, CPC Idaho Falls ID Peggy Jo Towns, CPC Meridian ID Donna Kay Kelley, CPC Middleton ID Teresa Magnusson, CPC Twin Falls ID Rhonda Mae Moyers, CPC Bartonville IL Christina Ann Thompson, CPC Biggsville IL Pamela Chmielewski, CPC Bourbonnais IL Amanda Dyson, CPC Calumet Park IL Lynn M Markmann, CPC Chicago IL Bianka Noble, CPC Chicago IL Ashley Miller, CPC Clinton IL Sarah Elizabeth Waller, CPC Collinsville IL Tenille Marielle Mason, CPC Country Club Hills IL Larry Williams, CPC Dixon IL Amy Dianne Cavazos, CPC, CPC-H, CPMA Forreston IL Rachel Coon, CPC, CPC-P, CPMA Lebanon IL Cindy Szczypiorski, CPC Lockport IL Brenda Bryant, CPC Mascoutah IL Jodi Hobbs, CPC Normal IL Rose Giacobbe, CPC Orland Park IL Kathryn Reiners, CPC Park Ridge IL Debbie Kay Perdun, CPC Peoria Heights IL Jana Osmani, CPC Rochelle IL Beth A LaFollett, CPC Washington IL Lisa Lynn Staggs, CPC Yates City IL Kathleen M Mills, CPC Carmel IN Sara Feulner, CPC Evansville IN Jamie D Miller, CPC Evansville IN Holly Perry, CPC Evansville IN Diane L Farlee, CPC, CPMA Ft Wayne IN Jane C Moore, CPC Greens Fork IN Karamjeet Kaur, CPC Greenwood IN Jakkia Baker, CPC Indianapolis IN Jocelyn M Forehand, CPC Indianapolis IN Rebecca Ann Randolph, CPC Indianapolis IN Kathy D Fischer, CPMA Kokomo IN Martha M Blair, CPC Martinsville IN Julie Ann Hayden, CPC Martinsville IN Raquel L Cooper, CPC Paragon IN Crystal Ann Zoller, CPC Paragon IN Taffy J Toby, CPC, CPMA Sellersburg IN Tammy Anderson, CPC South Bend IN Kelly Juhas, CPC South Bend IN Ruth Ann Yoder, CPC Wakarusa IN Rita Watkins, CPC Easton KS Jane Schnedler, CPC Manhattan KS Lisa Carvara, CPC Overland Park KS Elizabeth Marie Woolsey, CPC Spring Hill KS Julie Lynn Moran, CPC Topeka KS Kris Aust, CPC Ashland KY Melody Rose Gaddie, CPC Cub Run KY Tiffany Leigh Ferguson, CPC Elizabethtown KY Lori Lee Haynes, CPC Elizabethtown KY Linda Renee Stamp, CPC, CPMA, CPC-I Elizabethtown KY Rhonda Dearwester, CPC Falmouth KY Jannette Gayle Nickels, CPC Lawrenceburg KY Kathy Martha, CPC Lexington KY Jennifer Phillips, CPC-P Liberty KY Jeanie Marie Branham, CPC Prestonburg KY Angela Janine Voros, CPC Winchester KY Lydia Jumonville, CPC Albany LA Sonja Butler, CPC-P Baton Rouge LA Crystal G Lavergne, CPC Carencro LA Patricia Wynne, CPC Covington LA Toni Richard, CPC Geismar LA Janet K Annis, CPC, CPC-H New Orleans LA Margaret Folse, CPC Plaquemine LA Katherine Rivers, CPC Slidell LA Melissa McNaughton, CPC St Rose LA Lois Mouton, CPC Sunset LA Angeliki Medrano, CPC, CPMA Brookline MA Suzanne Goss, CPC Haverhill MA Annique Bala, CPC-H Mattapan MA Trina Mary Carbonneau, CPC Millbury MA Theresa Rines, CPC Milton MA Sara Fales, CPC Monson MA Mary Leitch, CPC Road MA Traci-Ann Garwacki, CPC Southwick MA Janet Robertson, CPC Spencer MA Christine T Groves, CPC Swansea MA Barbara Zoia, CPC Wareham MA Linda Balawender, CPC Worcester MA Jeannine Dunn, CPC Columbia MD Lynne Severn, CPC, CPMA Frederick MD Mwikali Mutia, CPC, CPC-H, CPC-P Landover MD Donna Sistare, CPC Laurel MD David J Freedman, CPC, CPMA Silver Spring MD Amy L Burrows, CPC Kittery ME Mary Emerson, CPC Byron Center MI Roxie Hawkins, CPC, CPC-H Canton MI Susan Marsee, CPC China MI Kelly Adelsburg, CPC Clinton Township MI Arlene T Spahr, CPC-H Grand Haven MI Shirley A Bryant, CPC Grand Rapids MI Keli Morgan, CPC Grand Rapids MI Rhonda Pawlanta, CPC Grand Rapids MI Judy Taylor, CPC Grand Rapids MI Melanie Lewis, CPC Harper Woods MI Deb Amos, CPC Hickory Corners MI Janet Lynn Crunk, CPC Highland MI Susan Lesky, CPC Holland MI Errika Mundae Krause, CPC Holly MI Glenda Kral, CPC Hudsonville MI Christine Perko, CPC Livonia MI Robyn Mileski-Iacoangeli, CPC Monroe MI Deborah Sue Walker Francisco, CPC Plainwell MI Jennifer Rogowski, CPC Reed City MI Holly M Morris, CPC Rochester Hills MI Lee Etta Cadotte, CPC Saginaw MI Jill K Biggin, CPC Bemidji MN LeeAnn Marie Hill, CPC Bemidji MN Daniel Goe, CPC Champlian MN Mickie Kummer, CPC, CPMA Ashland MO Kathryn Nash, CPC Blue Springs MO Lynn M Tucker, CPC Fenton MO Denise Leach, CPC Fulton MO Linda Ball, CPC-H, CPMA Independence MO Mary Frances Murphy, CPC Kansas City MO Shirley A Upschulte, CPC Kansas City MO Tricia G Callahan, CPC Lees Summit MO Ronna Crocker, CPC Ozark MO Tina R Wadkins, CPC, CPMA Peculiar MO Tammy McMahan, CPC, CPMA Pleasant Hill MO Tami K Dunn, CPMA Rolla MO Denelle Lynn Martinez, CPC Sugar Creek MO Patricia A Strubberg, CPC, CPMA, CPC-I Union MO Robyn Crews, CPC Warrenton MO Jimmie Richmond, CPC Gulfport MS Tracy Lynette Blotsky, CPC Clancy MT Julie Sakaguchi, CPC, CPC-H Helena MT Patricia Scarborough, CPC Asheville NC Karen Trampler, CPC Charlotte NC Alicia C Biggers, CPC Concord NC Summer Batts, CPC Elizabeth City NC Melissa L Labarge, CPC Knotts Island NC Terry S Oxendine, CPC Lumberton NC Deborah Ruffner, CPC Newton NC Amy Carlyle, CPMA Rockingham NC Tina Flynn, CPC Rocky Point NC Sondra Shelton, CPC South Mills NC Wendy S Parham, CPC Thomasville NC Keiasha Scott, CPC Winston Salem NC Crystal G Stocks, CPC Winston Salem NC Kathleen Traylor, CPC Bellevue NE Brenda L Williams, CPC Lincoln NE Marylynne Chavanelle, CPC Concord NH Shannon Marie Stemp, CPC Goffstown NH Jean Chenette, CPC Londonderry NH Janice L Carrier, CPC, CPMA Manchester NH Sarah Grugnale, CPC Manchester NH Alissa Dugrenier, CPC Penacook NH Doreen A Bahlman-Brandes, CPC, CPMA Berkeley Hts NJ Sandra M Truskin, CPC Berlin NJ Patricia Thompson, CPC Dover NJ Kathleen M Flynn, CPC Marlton NJ Erin Merendino, CPC Marlton NJ Marlene G Faulkner, CPC Old Bridge NJ Jennifer Breedlove, CPC Paulsboro NJ Heena Goculdas, CPC Plainsboro NJ Dominica Cali, CPC-H River Vale NJ Kristine Nystrand, CPC Rockaway NJ Alexandra Procopio, CPC Vineland NJ Teri Olson, CPC, CPMA Edgewood NM Rebecca Griffin, CPC Farmington NM Linda Monchamp, CPC Farmington NM Bonnie Romero, CPC Socorro NM Misty Styron, CPC Virginia Beach VA Melissa Hemmert, CPC Reno NV Mary Ann Preston, CPC Reno NV Kerri Nielson, CPC-H Winnemucca NV Joanna M Roberts, CPC Albany NY Diana Durcan, CPC Apalachin NY Kimberly A Quinlan, CPC Avon NY Patricia E Stampfler, CPC, CIRCC Binghamton NY Janet Rainey, CPC Bronx NY Stephen R Witcher, CPC Bronx NY Claribel Lazare, CPC Brooklyn NY Judy Ng, CPC-H Brooklyn NY Jody Ann Pomato, CPC Burnt Hills NY Karen Hoelscher, CIRCC Cheektowaga NY Di Xu, CPC-H Clifton Park NY Sherry Luree Havard, CPC Fort Drum NY Denise M Marcellus, CPC, CPMA Gouverneur NY Marion Witt, CIRCC Morris NY Rina C Syracuse, CPC New Rochelle NY Jennifer Murphy, CPC New Windsor NY Christine Johnson, CPC Newburgh NY Kathy Kazakoff, CPC Poughkeepsie NY Janina Urquhart, CPC Poughkeepsie NY Kysha West, CPC Rosedale NY Ellen M Eckl, CPC Schenectady NY Karen Pettit, CPC, CPMA Shirley NY Shannon M Lafave, CPC Sleepy Hollow NY Claire Sheila VanVorst, CPC, CPC-H Watervliet NY Ron J George, CPC Westchester NY Nikki Doulilis, CPC Akron OH Ashley M Meyers, CPC Ashtabula OH Maureen Garris, CPC Aurora OH Dana Petras, CPC Brook Park OH Grace M Mollica, CPC Brunswick OH Kari Louise Conley, CPC Centerville OH Sonda Kunzi, CPC Chardon OH Nicole Ayers, CPC Cincinnati OH Joanne M Mink, CPC Cincinnati OH Cindy E Zimmerman, CPC, CPC-H Cincinnati OH Mischelle L Allanson, CPC Cleveland OH Sheila Linley, CPC Columbus OH Michelle Lizardi, CPC Columbus OH Norma Mccune, CPC Dayton OH Nicole Marie Knepper, CPC Elyria OH Debra Wickliffe, CPC Enon OH Geraldine P Fisher, CPC Fairview Park OH Jenifer Salamah, CPC Fairview Park OH Valerie C Konkoli, CPC Garfton OH Michelle Marie Blazek, CPC Grafton OH Dorothy Athey, CPC Hamilton OH Teri Coy, CPC Harrod OH Cynthia Craig, CPC Hudson OH Helen Nogaj, CPC-H Johnstown OH Valerie J Kline, CPC Lima OH Devon McKinley, CPC Lockbourne OH Kimberly Jeanette Massie, CPC Lorain OH Stephanie Green, CPC Massillon OH Kathryn Ann Stull, CPC, CPMA Maumee OH Sheri A Kuty, CPC Mentor OH Hollis A Miker, CPC Rocky River OH Brenda Johnson, CPC Seville OH Cynda Lynn Sims, CPC South Euclid OH Celeste Ann Horvath, CPC Twinsburg OH Susan Eileen Good, CPC Youngstown OH

38 AAPC Coding Edge

newly credentialed members

Andrea Callow, CPC Zanesville OH Cathy Freriks, CPC Zanesville OH Michelle Rognon, CPC Zanesville OH Laura Phillips, CPC Bartlesville OK Denice R Finch, CPC Hobart OK Marilyn Maple, CPC Miami OK Patricia Diane Nelson, CPC Moore OK Kathy Dean, CPC, CPC-H, CPC-P, CPMA Norman OK Melinda Johnson, CPC Norman OK Patricia Anderson, CPC Oklahoma City OK Amber Arnall, CPC Tahlequah OK Joanne James, CPC Tulsa OK Rachel Marie Gaskey, CPC Albany OR Nicole Lynn Francois Bergstrom, CPC Eugene OR Brooke Fossati, CPC Tualatin OR Sarah Eschette, CPC Veneta OR Darylynne L Cortazar, CPC Warm Springs OR Dr. Marinilda Rodrguez, CPC Allentown PA Toni M Willoughby, CPC Aston PA Deborah Hildebrandt, CPC Audubon PA Joan M Kitchen, CPC Benton PA Dawn M Couch, CPC, CPC-H Burgettstown PA Annmarie Torbik, CPC Chadds Ford PA Laura Lee Carbaugh, CPC Chambersburg PA Kimberly R Christman, CPC Chambersburg PA Julie Doucas, CPC Clifton Heights PA Sherri L Oehmler, CPC Cranberry Twp PA Terri M Marino, CPC Denver PA Shameka Kempson, CPC East Stroudsburg PA Kelly J Steele, CPC, CPC-H Elizabethtown PA Debra Ostrum, CPC Erie PA Charlene R Swaney, CPC Fairchance PA Joyce Lynn Cline, CPC Fayetteville PA Susan Johnston, CPC Folcroft PA Ann Dillard, CPC Glenside PA Lori McCann, CPC Greenville PA Rhonda C Canady, CPC Hermitage PA Kathleen A Bilotti, CPC Homes PA Mary Siegman, CPC Langhorne PA Nerine T D'Andrea, CPC Lansdowne PA Karen Gallagher, CPC Media PA Lenora M Bell, CPC Melrose Park PA Amanda Wilson, CPC Milroy PA Patricia Anne Stepek, CPC Monaca PA Debra Wright, CPC Mt Morris PA Tamara Lynn Aulisio, CPC Nanticoke PA Diane Kolesha, CPC North Huntingdon PA Diana M Sikes, CPC Orrstown PA Denise M Reynolds, CPC Parkesburg PA Tracy Ervin, CPC Philadelphia PA Sally Jenkins-Redgrave, CPC Rose Valley PA Tracey M Wadel, CPC Shippensburg PA Donna Laughlin, CPC Springfield PA Sandra Boyd Campagnini, CPC Upper Chichester PA Wanda Smith, CPC Walnutport PA Tawnya M Priego, CPC Waynesboro PA Lisa A Silvia, CPC Barrington RI Nancy Marie Boudreau, CPC Chepachet RI Patricia Paquette, CPC North Providence RI Jennifer Fantasia, CPC Pawtucket RI Michael P Watkinson, CPC Providence RI Marlene Beaulieu, CPC Tiverton RI Samantha Gibbs, CPC Charleston SC Allison McCutcheon, CPC Charleston SC Linda St Marie, CPC Charleston SC Bobbie Caulder, CPC, CIRCC Gray Court SC Nikita R Gadsden, CPC Ladson SC Amaris Grant, CPC Summerville SC Shauna Wilson, CPC Summerville SC Stephanie Taylor, CPC Burns TN Stephanie Dawn DeFriece, CPC Cleveland TN Carol Dabney, CPC Clinton TN Sara Wolf, CPC-H Franklin TN Christy Lynn Brown, CPC, CPMA Johnson City TN Sandra Sue Tipton, CPC Kingsport TN Jenny Harvey, CPC Knoxville TN Pam Helton, CPC, CPMA Knoxville TN Jessica Nicole Cable, CPC Maryville TN Janet Arleen Gryder, CPC Maryville TN Darrell T Gates, CPC Memphis TN

Donna Martin, CPC, CPC-H, CPC-P, CPC-I Memphis TN Darija Giniunaite, CPC, CPMA Nashville TN Veronica J Clark, CPC Niota TN LeAnna Phillips, CPC Nolensville TN Debbie Sue Cook, CPC Pall Mall TN Cynthia Hite, CPC-H Smyrna TN Carolynn J Sexton, CPC Speedwell TN Misty D Reuis, CPC Winchester TN Marla Benningfield, CPC Austin TX Brenda Pitts, CPC-H Austin TX Monica Pizana, CPC Corpus Christi TX Douglas Arrington, CPC-H, CPMA Dallas TX Mayra Velos, CPC Dallas TX Carrol R Kozerinsky, CPC, CPC-H El Paso TX Kathy Conrad, CPC Forney TX Stacie L Gavin, CPC Friendswood TX Kelli Nicole Puckett, CPC Garland TX Lorena Reyes, CPC Glenn Heights TX Chris A Tryka, CPC, CPMA Harlingen TX Dana Michel, CPC Haslet TX Wendy Stephenson, CPC Houston TX Sonia DeShalle Francis, CPC Humble TX Nellie Ann Bermudez, CPC-H Irving TX Lisa Robinson, CPC Leander TX Denise Lara, CPC Manor TX Gail Anne Davis, CPC Mckinney TX Juli Smith, CPC Paris TX Deborah Eudy, CPC Pasadena TX Monica Lopez, CPC-H Pleasanton TX Diana Walker, CPC Robstown TX Vanessa Ramirez, CPC San Angelo TX Lisa Brooks, CPC San Antonio TX Nancy Sands, CPC San Antonio TX Janice Vogel, CIRCC San Antonio TX Teri Ivie, CPC Lindon UT Elaine Ball Smith, CPC, CPMA Alexandria VA Elizabeth Browning Teasley, CPC, CPMA Belle Haven VA Cynthia W Winkle, CPC Charles City VA Patricia Crump, CPC, CPMA Chase City VA Carole A Monty, CPC Chesapeake VA Sherry K Reeves, CPC Chesapeake VA Tamara Antoinette Jeffries, CPC Danville VA Sandra Elliott Karaffa, CPC Fishersville VA Vicki Gilbert, CPC-H Fort Lee VA Renee Firsdon, CPC Hampton VA Katherine Payne Flemer, CPC, CPC-H Mechanicsville VA Brandi Nichol Pope, CPC Midlothian VA Kimberlee D Statton, CPC Midlothian VA Kristine Sterling, CPC Norfolk VA Veronica Harris, CPC, CPMA Palmyra VA Debra C Zelaya, CPC, CPMA Reedville VA Cenith Byrd, CPC Richmond VA Bridgett M Johnson, CPC Richmond VA Ruth I Nichols, CPC Richmond VA Bonita M Walls, CPC Richmond VA Virginia N Hylton, CPC Sandston VA Zane Bobbsemple, CPC Stephenson VA Linda Osenton, CPC Suffolk VA Bettina Dodd, CPC Troy VA Ann-Marie Bochicchio, CPC Virginia Beach VA Jocelyn D Howard, CPC Virginia Beach VA Donna W Sutherland, CPC Virginia Beach VA Shannon Morrison, CPC Waynesboro VA Ellen Ontko, CPC Woodbridge VA Liza Recto, CPC Woodbridge VA Nancy St. Croix, CPC Hinesburg VT Lisa Brown, CPC Ephrata WA Stacey Folden, CPC Peshastin WA Michael Ciriaco, CPC Seattle WA Melissa Van Patten, CPC Vancouver WA Jodi Lee DeRuyter, CPC Cedar Grove WI Terri Lyn Laatsch, CPC Clintonville WI Lynn Rachel Rudd, CPC Depere WI Susan Mary Calabrese, CPC Green Bay WI Lisa Marie Burns, CPC Hartford WI Emily Ramlow, CPC Hartland WI Cheryl Lynn Rempert, CPC Kewakum WI Beth Ellen Lozinski, CPC Kewaunee WI Kathleen Hosokawa, CPC Madison WI Kate Marie Reidell, CPC Menominee WI

Pamela Silbar, CPC Menomonee Falls WI Ona Bowman, CPC Milwaukee WI Judy Yang, CPC Milwaukee WI Susan Lynn Nelson, CPC New Berlin WI Amy F. Nett, CPC Oshkosh WI Janice Lynn Reynolds, CPC, CPMA, CEMC Racine WI Lucille Marie Fale, CPC Sheboygan WI Renee Coleman, CPC Spooner WI Peggy Hansen, CPC Union Grove WI Patricia Sonnemann, CPC, CIRCC Waukesha WI Terri J Walter, CPC West Allis WI Courtney Westfahl, CPC West Allis WI Kristine Wage, CPC Wind Lake WI Jennifer Ruth Payne, CPC, CPMA Pursglove WV Todd Eric Wise, CPC, CPC-H Wana WV Brandace Eckhardt, CPC Evansville WY

Apprentices

Angelina Jobin, CPC-A APO AE Kerry Dale McLeary, CPC-A APO AE Helen Fuatino Snyder, CPC-A APO AE Alexander Shirl Wasden, CPC-A APO AE Jacqueline Quintana, CPC-A Mission Viejo AE Angela Elizabeth Wenz, CPC-A Sterling Heights AE Shirley McBain, CPC-A Valparaiso AE Brittney Oliver, CPC-A Anniston AL Samantha Wilson, CPC-A Birmingham AL Derec Lynn Jeffers, CPC-A Oxford AL Nancy Sparks, CPC-A Southside AL A. Andrews Dean, CPC-A Vestavia AL Sheryl Marie Cooper, CPC-A Little Rock AR Caryl Elizabeth Chilldres, CPC-A Lonoke AR Kenda Almond, CPC-A Malvern AR Jeanne Alison, CPC-A North Little Rock AR Ginger S Day, CPC-A Sheridau AR Karen Denys Aday, CPC-A Sherwood AR Mikki Sapien, CPC-A Anthem AZ Karen D'Amelio, CPC-A Apache Junction AZ Melinda Hampton, CPC-A Apache Junction AZ Susan Etlinger, CPC-A Avondale AZ Rita Ellinghausen, CPC-A Chandler AZ Megan Maldonado, CPC-A, CPC-H-A Chandler AZ Carol Toburen, CPC-A Chandler AZ Swee Kheng Wong, CPC-A Cottonwood AZ Lori Martinez, CPC-A Goodyear AZ Tracy Ramos, CPC-A Goodyear AZ Denise Bauer, CPC-A Green Valley AZ Christina Ann Benally, CPC-A Houck AZ Terry Holder, CPC-A Mesa AZ Laurie Schaller, CPC-A Mesa AZ Amanda Ellen Abbott, CPC-A Overgaard AZ Anita Barahona, CPC-H-A Phoenix AZ Pamela Gillies, CPC-A Phoenix AZ Velina Ruelas, CPC-H-A Phoenix AZ Kelly Greifenkamp, CPC-A San Tan Valley AZ Lee Ping Wang, CPC-A San Tan Valley AZ Obra Scott, CPC-A Scottsdale AZ Nancy Hove, CPC-A Tempe AZ Cheryl Voss, CPC-A Tempe AZ Denise M Adams, CPC-A Tucson AZ Shannon Cardea, CPC-A Tucson AZ Jessica Elizabeth Collins, CPC-A Tucson AZ Jocelyn R Huesman, CPC-A Tucson AZ Betty Thorson, CPC-A Tucson AZ Carmen Dalia Garcia, CPC-A Anaheim CA Eleanor R Tan, CPC-A Anaheim CA Elecene A Simpson, CPC-A Buena Park CA Madison Grover, CPC-H-A Camino CA Jessica E Vigneri, CPC-A Canyon Country CA Lourdes Macavinta, CPC-A Cerritos CA Brenda Gomez, CPC-A Costa Mesa CA Marty Ann Reza, CPC-A Cypress CA Keturah Faith James, CPC-A Elk Grove CA Suzanne Kathleen Riker, CPC-A Escondido CA Debra Berger, CPC-A Hanford CA Anthony Cucinotti, CPC-A Huntington Beach CA Penny D Kalb, CPC-A Huntington Beach CA Swapna Ray, CPC-A Irvine CA

Jodi Peters, CPC-A Kelseyville CA Rajeshree Patel, CPC-A La Mirada CA Eiesha K McCoy, CPC-A Lake Forest CA Maria Helen Asis, CPC-A Lakewood CA Salina Foster, CPC-A Lodi CA Tenika Floyd, CPC-A Long Beach CA Concepcion Lopez Concepcion, CPC-A Los Angeles CA Michaela C Islao, CPC-A Los Angeles CA Barbara Satorius, CPC-A Orange CA Nargiza Karimbaeva, CPC-A Palo Alto CA Teodorico E Bacarro II, CPC-A Panorama CA Matthew Lardie, CPC-A Rio Linda CA Nichole Deforest, CPC-A Roseville CA Dianna Piety, CPC-A Roseville CA Anne Heard, CPC-A Sacramento CA Lindy Summers-Bair, CPC-A Sacramento CA Monica Serna, CPC-A San Diego CA Lisa Higashi, CPC-H-A San Jose CA Janet Thayer, CPC-A San Jose CA Jill Brown, CPC-A Santa Ana CA Kaitlen Shepard, CPC-A Santee CA Lynda Michelle Carlson, CPC-A Saugus CA Darlene Colvin, CPC-A Spring Valley CA Anna Marie Laman Matibag, CPC-A Stevenson Ranch CA Maria Rocio Abundez, CPC-A Sylmar CA Jamie Nicole Frank, CPC-A Twentynine Palms CA Elizabeth Jekielek, CPC-A Valencia CA Linden Lim, CPC-A Walnut CA Adria Chapman, CPC-A Aurora CO Francine Hoover, CPC-A Aurora CO Jenifer Mcmullin, CPC-A Aurora CO Analicia Navarro, CPC-A Aurora CO Helen Orr, CPC-A Centennial CO GoEun Choi, CPC-A Colorado Springs CO Tammy Chulick, CPC-A Colorado Springs CO Kimberly Eyermann, CPC-A Colorado Springs CO Elizabeth Hluska, CPC-A Colorado Springs CO Wendy Smelker, CPC-A Colorado Springs CO Jennifer Wade, CPC-A Colorado Springs CO Antoinette Smith, CPC-A Denver CO Megan Thoren, CPC-A Denver CO Cynthia Hoyle, CPC-A Estes Park CO Heather Washburn, CPC-A Fort Carson CO Maya Curtis, CPC-A Johnstown CO Margaret Richardson, CPC-A Peyton CO Beth M Vandagriff, CPC-A Pine CO Teresa Marie Dougherty, CPC-A Thornton CO Jodie Maria Gonzales, CPC-A Thornton CO Andrew James Wilson, CPC-A Thornton CO Brenda Wilson, CPC-A Wheat Ridge CO Sherri Lynne Moore, CPC-A Branford CT Debra Ann Mulnite, CPC-A Broad Brook CT Eric S Krueger, CPC-A Carroll CT Michele A Vasso, CPC-A East Haven CT Karen L Geary, CPC-A East Lime CT Cristina Renn-Chillogalli, CPC-A Hartford CT Constance Roberge, CPC-A Higganum CT Kristi M DiTolla, CPC-A Madison CT Sheena Roseboro, CPC-A Manchester CT Miriam Palumbo, CPC-A Middletown CT Hilda Davis, CPC-A Milford CT James C Jackson, CPC-A Naugatuck CT Erica Osborne, CPC-A Naugatuck CT Lidia Porczak, CPC-A New Britain CT Edwin Rivera, CPC-A New Britain CT Susan M Benvenuti, CPC-A North Haven CT Florence A Pimer, CPC-A Northford CT James Holmes, CPC-A South Windsor CT Katherine Looby, CPC-A Vernon CT Megan E Jackson, CPC-A Wallingford CT Karen F Marino, CPC-A Wallingford CT Marimargaret Fischer, CPC-A Newark DE Shannon Kathleen Watson, CPC-A Newark DE Victoria Wolfenden, CPC-A Newcastle DE Rob Roth, CPC-A Smyrna DE Charlene V Fanny, CPC-A Wilmington DE Sherine Velazquez, CPC-A Wilmington DE Amanda Busbee, CPC-A Alva FL Debbie Solti, CPC-A Aventura FL

Jayne Kollig, CPC-A Bonita Springs FL Amikam Pistiner, CPC-A Boynton Beach FL Carrie O'Neal, CPC-A Brooksville FL Katina Lowery, CPC-A Cape Coral FL Shidara Black, CPC-A Clearwater FL John Charles DeSano, CPC-A Clearwater FL Stacie Yvonne Jones, CPC-A Clearwater FL Margaret Ann Parhiskari, CPC-A Clearwater FL Stephen Michael Shafer, CPC-A Clearwater FL Stacy Busbee, CPC-A Ft Myers FL Naomi Chance, CPC-A Ft Myers FL Frank Horvath, CPC-A Ft Myers FL Nolan Joseph Hadsell, CPC-A Ft Pierce FL Liziana Rene Pierre, CPC-A Ft Pierce FL Michele Mills, CPC-A Holiday FL Sandra Barbara, CPC-A Jacksonville FL Berenika Kitto, CPC-A Lake City FL Timothy Mark Oxley, CPC-A Largo FL Nancy Hale, CPC-A Lehigh Acres FL Joyale Trenesa Johnson, CPC-A Lehigh Acres FL Laura Brown, CPC-A Loxahatchee FL Ginger Sawdy, CPC-A Lutz FL Leslie D Alvarez, CPC-A, CPMA Melrose FL Kimberly A Templer, CPC-A Middleburg FL Paula Bristol, CPC-A Naples FL Wendy Diaz-Suarez, CPC-A Naples FL Sara Gutierrez, CPC-A Naples FL Corey Nelson, CPC-A Naples FL Ashley Rozance, CPC-A Naples FL George Wingist, CPC-A Naples FL Christine Penzkofer, CPC-A New Port Richey FL Samantha Bobek, CPC-A Niceville FL Jasmin Tabora, CPC-A Orange Park FL Sandy Santana, CPC-A Palm Coast FL Heather Brienne Weiss, CPC-A Palm Harbor FL Patty J Kinard, CPC-A Panama City FL Susan Hagel, CPC-A Panama City Beach FL Kim Helen Smith, CPC-A Pompano Beach FL Natasha Keeling, CPC-A Port Orange FL Christy Gainous, CPC-A Port St Joe FL Larene Paterna, CPC-A Punta Gorda FL Gladimar Gerena, CPC-A Riverview FL Julie Metcalf, CPC-A Sarasota FL Alycia L Brown, CPC-A Sebastian FL MaryAnn Lynch, CPC-A Sebastian FL Laurie Ann Purtle, CPC-A Sebastian FL Brett Ripp, CPC-A Sebastian FL Melissa Metz, CPC-A St Cloud FL Mary Bennett, CPC-A St Petersburg FL Evelyn M Quick, CPC-A Summerfield FL Ma Michaela Basilio, CPC-A, CPC-H-A Tampa FL Brenda Lee Bryant, CPC-A Tampa FL Nikki L Finney, CPC-A Tampa FL Johnna Floyd, CPC-A Tampa FL Grace Gloster, CPC-A Tampa FL Robin Kaufman, CPC-A Tampa FL Bryan L King, CPC-A Tampa FL Emery John Ocon Laguimun, CPC-A Tampa FL Barbara Magdalena, CPC-A Tampa FL D'Anne Messer, CPC-A Tampa FL Ahmelyn Lim Pangambayan, CPC-A Tampa FL Jacqueline Purpura, CPC-A Tampa FL Sierra Spitnale, CPC-A Tampa FL Rosendo Urena, CPC-A Tampa FL Andrea Whitlock, CPC-A Tampa FL Dianne Hall, CPC-A Tyndall AFB FL Carlos Arias, CPC-A Valrico FL Jenny Brannon, CPC-A Venice FL Tami Christy, CPC-A Vero Beach FL Carole Kreider, CPC-A Vero Beach FL Vincent Everett Puchala, CPC-A Vero Beach FL Patricia Compton, CPC-A Weeki Wachee FL Maritza Ortiz, CPC-A Wellington FL Debbie Sherwood, CPC-A Wesley Chapel FL Connie Altman, CPC-A Winter Springs FL Bruce Lager, CPC-A Winter Springs FL Banu Rajagopal, CPC-A Alpharetta GA Leslie N Griffin, CPC-A Atlanta GA Frances Glover, CPC-A Augusta GA Brigitte A Lewis, CPC-A Augusta GA

www.aapc.com

October 2010

39

newly credentialed members

Jacqueline Herbert, CPC-A Conyers GA Barbara BeGasse, CPC-A Marietta GA Christy Leigh Witcher, CPC-A McDonough GA Tamekaus Timmons, CPC-A Saint Marys GA Olga Evans, CPC-A Savannah GA Mark Edison Flora, CPC-A Honolulu HI Samantha Rosbury, CPC-A Burlington IA Lisa Ann Fratzke, CPC-A Cedar Rapids IA Tracy Wilson, CPC-A Council Bluffs IA Janet Marie Habick, CPC-A Des Moines IA Jean Marie Gehling, CPC-A Shenandoah IA Sharon R Brown, CPC-A Boise ID Brittany Japs, CPC-A Boise ID Deborah Mitchell, CPC-A Boise ID Sandy Winjum, CPC-A Caldwell ID Barbara Barnes, CPC-A Kimberly ID Linda Thurston, CPC-A Meridian ID John Welsh, CPC-A Meridian ID Susan Rochelle Fisher, CPC-A New Plymouth ID Joseph Britton Lilly, CPC-A Twin Falls ID Wendy A Booi, CPC-A Ashkum IL Sue Austin, CPC-A Bourbonnais IL Deborah G Kershaw, CPC-A Bourbonnais IL Hollie Jean Ehrhardt, CPC-A Bradley IL Dianne Gladen, CPC-A Cary IL Michelle Hubbard, CPC-A Caseyville IL Christina M Riddle, CPC-A Collinsville IL Janis Welch, CPC-A Country Club Hills IL Melanie Floit, CPC-A Dekalb IL Lisa A Ray, CPC-A Dupo IL Bonnie Green, CPC-A Granite City IL Anne Marie Valenti, CPC-A Highland Park IL Jill Ann Gerber, CPC-A Kankakee IL M Elizabeth Provost, CPC-A Kankakee IL Lauren Adamo, CPC-A Lake in the Hills IL Trena White, CPC-A Litchfield IL Stacy Janssen, CPC-A Machesney Park IL Susan R Bowman, CPC-A Mt Morris IL Shawn Greenough, CPC-A Naperville IL Diana Lynn Hasler, CPC-A Pekin IL Sandra Marie Vaupel, CPC-A Pekin IL M Noelle Natale, CPC-A Peoria IL Ann Beeler, CPC-A Raymond IL Kim Louis, CPC-A Rochelle IL Jackie Sue Wagner, CPC-A Rockford IL Kimberly Wiggins, CPC-A Rockford IL Pauline Ruth Parish, CPC-A Watseka IL Sherri Kane, CPC-A Wood River IL Stephanie Hayworth, CPC-A Arlington IN Mythina Crump, CPC-A Charlestown IN Christi Poor, CPC-A Charlestown IN Kerilee Emmenegger, CPC-A Economy IN Paul Angermeier, CPC-A Evansville IN Julie S Scotton, CPC-A Fishers IN Kari McGrath, CPC-A Franklin IN Michelle James, CPC-A Georgetown IN Elizabeth Keith, CPC-A Hardinsburg IN Fabio Jimmy Negro, CPC-A Indianapolis IN Jessica Higdon, CPC-A Jeffersonville IN Edna Zessin, CPC-A Jeffersonville IN Rachel Nethery, CPC-A Lanesville IN Venita Sterrett, CPC-A Lexington IN Amany Ali, CPC-A New Albany IN Shanita Sanders, CPC-A Noblesville IN Clare Case, CPC-A Richmond IN Debra Wise, CPC-A Salem IN Melissa Kenney, CPC-A South Bend IN Latricia D Stephens, CPC-A Augusta KS Theresa Chandler, CPC-A Basehor KS Laura Lauber, CPC-A Bel Aire KS Taressa Richey, CPC-A Caney KS Gayle Gray, CPC-A Coffeyville KS Kati E Price, CPC-A El Durado KS Darcy Christine Fox, CPC-A Haysville KS Leanne Rae Pedersen, CPC-A Haysville KS Laura J Stevens, CPC-A Haysville KS Dawn Whitney Harper, CPC-A Lawrence KS Tammy S Pope, CPC-A McLouth KS Mary L Schmidt, CPC-A Mt Hope KS Dammon Vincent Alexander, CPC-A Mulvane KS Kelly Leach, CPC-A Mulvane KS Peggy Degnan, CPC-A Overland Park KS Beverly J Knueppel, CPC-A Park City KS Ronette M Robinson, CPC-A Topeka KS Charlene Lee Sales, CPC-A Topeka KS Janelle A Dane, CPC-A Valley Center KS Roberta Ann Barlow, CPC-A Wichita KS Cathy Diane Davis, CPC-A Wichita KS

Shaughnessy Annette Davis, CPC-A Wichita KS Krista Marie Gillespie, CPC-A Wichita KS Rhiannon Andrea Hernandez, CPC-A Wichita KS James Daniel Huggins, CPC-A Wichita KS Wanda L Janzen, CPC-A Wichita KS Larinda J Johnson, CPC-A Wichita KS Karen Kasten, CPC-A Wichita KS Marla R Moore, CPC-A Wichita KS Billie Jean Myers, CPC-A Wichita KS Jennifer E Reynard, CPC-A Wichita KS Joni Rene Wells, CPC-A Wichita KS Talissa Marie Wood, CPC-A Wichita KS Brittany Miesha Wright, CPC-A Wichita KS Chasitity Beane, CPC-A Alexandria KY Jeffrey Scott Reed, CPC-A Alexandria KY Tamberlyn Bradley, CPC-H-A Bardstown KY Dee Meyers, CPC-A Clay KY Dinah Carole Lussier, CPC-A Dixon KY Michelle Liegh Brenner, CPC-A Elizabethtown KY Beverly Daugherty, CPC-A Flatwoods KY Katrina Mclean, CPC-A Georgetown KY Jennifer Boles, CPC-A LaGrange KY Betty Elaine Taylor, CPC-A Lancaster KY Rowena Robinson, CPC-A Lawrenceburg KY Alice J Hazelett, CPC-A Lexington KY Susan Marnatti, CPC-A Lexington KY Lane Meek, CPC-A Lexington KY Scott Ross, CPC-A Lexington KY Karl J Dence, CPC-A Londonville KY Jennifer Ann Cash, CPC-A, CPC-H-A Louisville KY Angela Rene' Coffee, CPC-A, CPC-H-A Louisville KY Jennifer Lee Cox, CPC-A, CPC-H-A Louisville KY Amanda Higdon, CPC-A Louisville KY Keith James Livermore, CPC-A Louisville KY Melissa Anne Matheis, CPC-A, CPC-H-A Louisville KY Michael Nall, CPC-A Louisville KY Kerry K Summers, CPC-A, CPC-H-A Louisville KY Luanne Pamela Vogt, CPC-A Louisville KY Amber Wilson, CPC-A Louisville KY Elizabeth Arwen Johnson, CPC-A Madisonville KY Karen Harp, CPC-A Nicholasville KY Tina Waller, CPC-A Nicholasville KY Kimberly Edison, CPC-A Olive Hill KY Curtis D Dunn, CPC-A Owensboro KY Pamela Markham, CPC-A Richmond KY Holly Chance, CPC-A Shelbyville KY Jean B Adams, CPC-A Stanford KY Tonecia Penman, CPC-A Stanford KY Cathy Arleen Barnett, CPC-A, CPC-H-A Taylorsville KY Kimberly Blair, CPC-A Tomahawk KY Birgit Seidel, CPC-A Covington LA Katy Matte, CPC-A Denham Springs LA Michelle Melancon, CPC-A Denham Springs LA Cara Perkins Nunez, CPC-A Metairie LA Crystal Diane Brossett, CPC-A Shreveport LA Crystal April Cook, CPC-A Shreveport LA Berlinda A Hall, CPC-A Shreveport LA Senia Danielle Woods, CPC-A Shreveport LA Rachel Diane Clay, RN, CPC, CPC-A Zachary LA Deborah Follett, CPC-A Agawam MA Kim Rose, CPC-A Attleboro MA Micha Flanary, CPC-A Belchertown MA Jean Marketkar, CPC-A Boylston MA Vivian S Wang, CPC-A Burlington MA Lola Nowak, CPC-A Charlton MA Margaret L Coburn, CPC-A East Dennis MA Cynthia Payne, CPC-A Easthampton MA Ellen Waddell, CPC-A Holden MA Christina Higgins, CPC-A Hudson MA Paula Murdock, CPC-A Leicester MA Gail Parravicini, CPC-A Marlborough MA Michael Ferry, CPC-A Northampton MA Lori D Perkins, CPC-A Orange MA Diane Hannify-Broughton, CPC-A Peabody MA Susan Ann Huling, CPC-A Rehoboth MA Christin Lavargna, CPC-A Revere MA Jennifer Sheehan, CPC-A Southbridge MA Faustine Rios, CPC-A Springfield MA Robin Meadows, CPC-A Whitinsville MA Amanda McGinn, CPC-A Worcester MA Melissa January, CPC-A Baltimore MD Matthew Riggs, CPC-A Baltimore MD Betty Sye, CPC-A Baltimore MD Michelle Burnham, CPC-A Bel Air MD Leslie Callison, CPC-A Bel Air MD Sue Thiess, CPC-A Bel Air MD Amy Combs, CPC-A Brooklyn MD Kelly Cooper, CPC-A Clear Spring MD

Svetlana Zolotar, CPC-A Columbia MD Jeannette Ireland, CPC-A Ellicott City MD Elton Jewell, CPC-A Gaithersburg MD Indiana Sims, CPC-A Gaithersburg MD Susan Spaulding, CPC-A Hanover MD Rebecca Keitz, CPC-A Joppa MD Rhonda Coe, CPC-A Mitchellville MD Jayita Das, CPC-A Owings Mills MD Lauren Justine Coffman, CPC-A Parkton MD Jayasree Kundu, CPC-A Potomac MD Maliki Ouro Koura, CPC-A Silver Spring MD Theresa Tran, CPC-A Silver Spring MD Laurie Curtin, CPC-A Rockland ME Nancy Tuffs, CPC-A Belmont MI Megan Russell, CPC-A Berkley MI Nancy Church, CPC-A Berrien Springs MI Dante L Espiritu, CPC-A Bloomfield Hills MI Lubna Navaid, CPC-A Canton MI Lori Sandri, CPC-A Clinton Twp MI Ashlee McInnes, CPC-A Commerce MI Mary Ann Milewski, CPC-A Detroit MI Toni Nemeth, CPC-A Dowagiac MI Lisa Barr, CPC-A Eastpointe MI Linda Anne Wilson, CPC-A Eastpointe MI Elva Mae Phelps, CPC-A Flushing MI Marie Wylie, CPC-A Gregory MI Sharon Dost, CPC-A Haslett MI Kendall Dane, CPC-A Highland MI Thelma Hicks, CPC-A Holland MI Alysia Julia Kent, CPC-A Holland MI Katie Van Goor, CPC-A Holland MI Tricia Joy Berends, CPC-A Jenison MI Jillian Renee Vandervoord, CPC-A Kent City MI Brandi Lynn Tebo, CPC-A Kentwood MI Karyn Wilson, CPC-A Lansing MI Marie Cormack, CPC-A Livonia MI Michelle Devlin, CPC-A Livonia MI Theresa Eberly, CPC-A Livonia MI John Hodges, CPC-A Livonia MI Sarah Redding, CPC-P-A Livonia MI June Brown, CPC-A Macomb MI Cheryl Licari, CPC-A Macomb MI Margaret Janssen, CPC-A Milford MI Anne Lindquist, CPC-A Muskegon MI Ellen Horvath, CPC-A Northville MI Ashok Kumar Tyagi, CPC-A Novi MI Miriam Borenstein, CPC-A Oak Park MI Alysha Blemaster, CPC-A Perrinton MI Lori Harris, CPC-A Plainwell MI Karen Ortwine, CPC-A Pontiac MI Mary Balsam, CPC-A Romeo MI Catharine Pearce, CPC-A Romeo MI Rochelle Juni, CPC-A Royal Oak MI Beth Boyd, CPC-A Shelby Township MI Donna Kennedy-Williams, CPC-A Shelby Township MI Alanna Griffith, CPC-A Southfield MI Kristen Dolores Burkwalt, CPC-A Sparta MI Jane Mars, CPC-A Sparta MI Diane Polk, CPC-A St Clair Shores MI Danette Gurzell, CPC-A Sterling Heights MI Michelle Trombley, CPC-A Warren MI Natalie Iscaro, CPC-A Washington MI Marcia Zeski, CPC-A Washington MI Cheryl Wright, CPC-A Washington Township MI Rita Kay Green, CPC-A Waterford MI Sandy Berry, CPC-A Wyandotte MI Shanta Hill, CPC-A Minneapolis MN Heather N Chance, CPC-A Arnold MO Anna Marie Vieira, CPC-A Barnett MO Jennie Lynn Holt, CPC-A Bellflower MO Krista Dawn Dement, CPC-A Bismarck MO Lindsey M Evans, CPC-A Caledonia MO Heather N Schaefer, CPC-A DeSoto MO Renee Lynn Schaefer, CPC-A DeSoto MO Angela Rachelle Behan, CPC-A Fenton MO Tabitha Lynn Anderson, CPC-A Florissant MO Antonio Lewis Webb, CPC-A Florissant MO Kelley Worthley, CPC-A Harrisonville MO Tamara Ann Packard, CPC-A High Ridge MO Katie Schirlls, CPC-A Holden MO Tammy R Beasley-Schaefer, CPC-A Holts Summit MO Jessica L Robertson, CPC-A Independence MO Staci Austin, CPC-A Kansas City MO Lyndon Herring, CPC-A Kansas City MO Ashley Wilson, CPC-A Kansas City MO Nadine Folkerts, CPC-A O'Fallon MO Alana Vigil, CPC-A O'Fallon MO Melissa Kathleen Hess, CPC-A Pacific MO

Sarah Jones, CPC-A Pacific MO Sharon Young, CPC-A St Charles MO Danielle Lee Burns, CPC-A St Joseph MO Brandi Lin Dredge, CPC-A St Joseph MO Daniel Henderson, CPC-A St Joseph MO Pamela McGinnis, CPC-A St Joseph MO Mary Baugh, CPC-A St Louis MO Lisa Ann Bushmeyer, CPC-A St Louis MO Sharon Kay Sifford, CPC-A St Louis MO Kimberli Marie Trenholm, CPC-A St Louis MO Rebecca Jean Parker, CPC-A Valley Park MO Tammy Lynn Kahl, CPC-A Washington MO Penny Renee Lear, CPC-A Washington MO Merry Hancock, CPC-A Biloxi MS Shannon Lee Hettich, CPC-A Biloxi MS Tiffany Nicole Sanford, CPC-A Courtland MS Loretta S Guthrie, CPC-A Gulfport MS Katherine Nesshoever, CPC-A Gulfport MS Carrie Lynn Adkins, CPC-A Horn Lake MS Lakisha Lovette Eagins, CPC-A Jonestown MS Camela L Myles, CPC-A Marks MS Wanda Gail Barrier, CPC-A Olive Branch MS Tammie S Gordon, CPC-A Olive Branch MS Janessa Faulkner, CPC-A Verona MS Angelia Faye Smith, CPC-A Walls MS Bonnie Benson, CPC-A Billings MT Kelli Graf, CPC-A Billings MT Frances Carol Oberlander, CPC-A Billings MT Jocelyn Peters, CPC-A Billings MT Angela Petty, CPC-A Billings MT Kathy Smolenski, CPC-A Billings MT Kathryn Watt, CPC-A Billings MT Kathleen Anne Zigweid, CPC-A Billings MT Karen Lee Teeters, CPC-A Laurel MT Traci Oblender, CPC-A Worden MT Pam Robinson, CPC-A Asheville NC Amelia Love Banks-Foote, CPC-A Castle Hayne NC Katrina Anthony, CPC-A Charlotte NC Twanette Bethea, CPC-A Charlotte NC Keisha Jones, CPC-A Charlotte NC Linda H Marshall, CPC-A Charlotte NC Emily McCradden, CPC-A Charlotte NC Janet Pierce, CPC-A Charlotte NC Margaret Prohammer, CPC-A Charlotte NC Cortney Butler, CPC-A Concord NC Molly J Wisehart, CPC-A Concord NC Mary Catherine Etz, CPC-A Gold Hill NC Megan Gutierrez, CPC-A Greensboro NC Mary Bennett, CPC-A Hampstead NC Kelli Renee McAlister, CPC-A Hickory NC Erin Shebatka, CPC-A Hickory NC Heather Newsome, CPC-A Jacksonville NC Jessica Lentz, CPC-A Kannapolis NC Allison Freeman, CPC-A La Grange NC Keaira Pettiford, CPC-A Leasburg NC Jennifer Gaither, CPC-A Lexington NC Gina A Odom, CPC-A Lexington NC Sandra McLeod, CPC-A Mooresville NC Ruth Smith Franklin, CPC-A Morganton NC Barbara Hawkins, CPC-A Newport NC Marianne Roberts, CPC-A Pinebluff NC Robert Fox, CPC-A Raleigh NC Leslie Keeton, CPC-A Roxboro NC Henry Terry, CPC-A Roxboro NC Angela Gore, CPC-A Salisbury NC Jessica Gaither, CPC-A Statesville NC Kayla Gonzalez, CPC-A Stoneville NC Filipina Horne Teachey, CPC-A Swansboro NC Michelle M Loyd, CPC-A Trinity NC Angela Kruger, CPC-A Waxhaw NC Barbra R Rawson, CPC-A Winston Salem NC Sara Thiele, CPC-A Bismarck ND Cassandra Keller, CPC-A Fargo ND Tammie Ficenec, CPC-A Omaha NE Kristin J Martinek, CPC-A Omaha NE Rebekah Helan Mortimore, CPC-A Omaha NE Doris Cote, CPC-A Antrim NH Douglas C Gray, CPC-A Dover NH Michele DeMarco, CPC-A East Hampstead NH Laura Kafegelis, CPC-A Hooksett NH Sue Glenzer-Thomas, CPC-A Hudson NH Christy Galan, CPC-A Manchester NH Melissa McMillan, CPC-A Manchester NH Elizabeth Lawrence-Couture, CPC-A Melvin Village NH Deborah Ouellette, CPC-A Merrimack NH Robin Senechal, CPC-A Merrimack NH Angela Hoffard, CPC-A New Boston NH Tina Wisniewski, CPC-A Cream Ridge NJ

Patricia Peterson, CPC-A Elmwood Park NJ Catherine Rotondi, CPC-A Hamilton Square NJ Teresa Mazzarino, CPC-A Holmdel NJ Diana Visco, CPC-A Lawrenceville NJ Manisha Gandhi, CPC-A Livingston NJ Nicole DiGiovanni, CPC-A Manalapan NJ John Compson, CPC-A Plainsboro NJ Michele Bauman, CPC-A Vineland NJ Jennifer Lee Bean, CPC-A Vineland NJ Ellen Beres, CPC-A Vineland NJ Edie Camel, CPC-A Westampton NJ Robin Hoffman, CPC-A Albuquerque NM Verchera Reed, CPC-A Albuquerque NM Amanda Watson, CPC-A Los Alamos NM Deborah Baca, CPC-A Los Lunas NM Susan Samuels, CPC-A Moriarty NM Leandria Benton, CPC-A Rio Rancho NM Kriistal Diaz, CPC-A Rio Rancho NM Loren Anderson, CPC-A Las Vegas NV Adrienne Kent, CPC-A Reno NV Anntwanette Leteese Jones, CPC-A Amherst NY Danielle Nicole Filbeck, CPC-A Amsterdam NY Lou Ann Kimball, CPC-A Bainbridge NY Pamela J Saraceni, CPC-A Baldwinsville NY Ruth E Carter, CPC-A Bridgeport NY Yolanda Gibbs, CPC-A Bronx NY Anginell D Reese, CPC-A Buffalo NY Elisabeth Ann Bink, CPC-A Cambridge NY Alice F Watkins, CPC-A Canastota NY Deborah J Kolb, CPC-A Cato NY Rhonda L Mihalko, CPC-A Clarence NY Deirdre Marangiello, CPC-A Cortlandt Manor NY Michael J Haddix, CPC-A East Rochester NY Cynthia J Williams, CPC-A East Rochester NY Judith Ginter, CPC-A Elmira NY Michelle Ryan, CPC-A Elmira NY John Namerow, CPC-A Fishkill NY Ashley Lynn Augustine, CPC-A Horseheads NY Peter E Cloutier, CPC-A Kenmore NY Alissa Rae Sparceno, CPC-A Kenmore NY Shaleen M Breed, CPC-A Lafayette NY Laurel E DiGiulio, CPC-A Liverpool NY Heather A Knapp-Beardsley, CPC-A Liverpool NY Kellie Lynne Freaney, CPC-A Loch Sheldrake NY Richard M Tomaino, CPC-A Lockport NY Donna Wickham, CPC-A Marathon NY Joanne Gladysz, CPC-A Mattydale NY Alyssa Ellison, CPC-A Middletown NY Deborah A Huff, CPC-A Mt Kisco NY Brooke Ganio, CPC-A Mt Vision NY Clinton Parks, CPC-A New Rochelle NY Madhavi Kattela, CPC-A Niskayuna NY Tracy Sherman, CPC-A Niskayuna NY Sharon Edsall Stadelmaier, CPC-A Odessa NY Mary E Morseon, CPC-A Orchard Park NY Nancy J Anselmo, CPC-A Rochester NY Christine M Arena, CPC-A Rochester NY Katherine Gail Bryant, CPC-A Rochester NY Ann Marie Dana-Deutsch, CPC-A Rochester NY Tamara J Finch, CPC-A Rochester NY Paul J Milo, CPC-A Shrub Oak NY Gordon Tussing, CPC-A Snyder NY Karen Tussing, CPC-A Snyder NY Michelle C Dixon, CPC-A Syracuse NY Elaine M Lawrence, CPC-A Tonawanda NY Rochelle M Perrington, CPC-A Tonawanda NY Mary Eck, CPC-A Unadilla NY Agatha E Russell, CPC-A Valatie NY Ana Pedro, CPC-A Walden NY Lonna Vandereems, CPC-A Watkins Glen NY Barbara Soprano-Trudeau, CPC-A Waverly NY Carrie Beth Pellett, CPC-A Webster NY Rebecca J Gordon, CPC-A West Henrietta NY David M Ferrer, CPC-A White Plains NY Jennifer L Petrie, CPC-A Williamsville NY Padmini Prasanna, CPC-A Williamsville NY Ellen J Morrell, CPC-A Akron OH Suzanne Michele Salzwimmer, CPC-A Akron OH Melinda G Chalfant, CPC-A Austintown OH Beth Ann Shaffer, CPC-A Austintown OH Deborah Lynne Kopanic, CPC-A Boardman OH Kelly A Kroboth, CPC-A Boardman OH Rachael Snyder, CPC-A Brewster OH Kristen Szalay, CPC-A Brook Park OH Lana K Ando, CPC-A Canal Fulton OH Candi Lee Frame, CPC-A Canfield OH Michelle A Carter, CPC-A Canton OH James H Jewell, CPC-A Clinton OH

40 AAPC Coding Edge

newly credentialed members

DeAnna J Carman, CPC-A Columbiana OH Jeanine Mellinger, CPC-A Columbiana OH Cynthia Grant, CPC-A Columbus OH Randolph Reagan, CPC-A Columbus OH Deborah Marie Crow, CPC-A Creston OH Tania Lee Robinson, CPC-A Doylestown OH Nicki L Rogers, CPC-A Doylestown OH Jeannie Marie Sivillo, CPC-A Eastlake OH Amy Rose, CPC-A Franklin OH April D Mantz, CPC-A Goshen OH Stacey Jones, CPC-A Heath OH Kimberly Susan Hunsbarger, CPC-A Hubbard OH Carrie Garrison, CPC-A Lakewood OH Tori Lynne Wilson, CPC-A, CPMA Lancaster OH Rebecca E Martin, CPC-A Lewis Center OH Louise Ann Martin, CPC-A Lowellville OH Miranda Nichole Leonard, CPC-A Mansfield OH Emily Magee, CPC-A Martinsville OH Emily Gimbel, CPC-A Mason OH Karen Rasch, CPC-A Mason OH Terrance H Pierce Sr., CPC-A Massillon OH Leanne Voshel, CPC-A Massillon OH Stacy Cooper, CPC-A, CPC-H-A Mineral Ridge OH Marilyn J Roth, CPC-A Mineral Ridge OH Rebecca A Whitmer, CPC-A Navaree OH Connie Barcus, CPC-A Newark OH Phillip Dunfee, CPC-A Newark OH Dianna McPherson, CPC-A Newark OH Kathy Sumner, CPC-A Newark OH Bonnie Matuszwski, CPC-A Niles OH Keisha McCartney, CPC-A Niles OH Wendy L Spatz, CPC-A North Canton OH Linda Romeo Desotell, CPC-A Poland OH Megan Christine Fitzpatrick, CPC-A Rittman OH Jan Marie Swartz, CPC-A Road OH Caitlin Irene Dirk, CPC-A South Euclid OH Jami Lynn Nance, CPC-A South Point OH Wendi Hall, CPC-A Struthers OH Shawn Hartley, CPC-A Toledo OH Rachael A Moore, CPC-A Toledo OH Jennifer Elizabeth Warner, CPC-A Wadsworth OH Lisa Williams, CPC-A Warren OH Dr. Joseph Lydon, CPC-A Westlake OH Tara Leigh Schubert, CPC-A Willoughby Hills OH Michelle L Henry, CPC-A Wooster OH Beth Herncane, CPC-A Wooster OH Edith Marie Pitcher, CPC-A Wooster OH Lisa McGeary, CPC-A Worthington OH Rebecca Anne Iacobucci, CPC-A, CPC-H-A Youngstown OH Sarah Allred, CPC-A Bartlesville OK Debbie Young, CPC-A Dewey OK Tammy Vaughn, CPC-A Oklahoma City OK Janie Bellinger, CPC-A Owasso OK Cynthia Light, CPC-A Sand Springs OK Amber Tarbet, CPC-A Sayre OK Angela Hanson, CPC-A Tulsa OK Angela Nave, CPC-A Tulsa OK Joia Washington, CPC-A Tulsa OK Angela Cail, CPC-A Albany OR Lori Ware, CPC-A Albany OR Paul Johnson, CPC-A Aloha OR Christian Buchanan, CPC-A Beaverton OR Chantell Reyes, CPC-A Beaverton OR Robin M Hlobeczy, CPC-A Corvallis OR Sandra J Schmidt, CPC-A Creswell OR Kathy Macomber, CPC-A Gresham OR Sonya Sheaver, CPC-A Hillsboro OR Jennifer Hughes, CPC-A Lebanon OR Patricia Wells, CPC-A Newberg OR Cindy Compton, CPC-A Portland OR Selma Krnjic, CPC-A Portland OR Francine Martin, CPC-A Portland OR Sharon Wilson, CPC-A Portland OR James Harsh, CPC-A Salem OR Sarah Barbour, CPC-A Tualatin OR Pamela Iosco, CPC-A Tualatin OR Kathy Brown, CPC-A Allentown PA Kathleen M Whalen, CPC-A Allentown PA Julie Bitting, CPC-A Ambler PA Tonya Trach, CPC-A Bath PA Michael Butchin, CPC-A Brookhaven PA Barbara J Wolfe, CPC-A Clark PA Jaimie Diehl, CPC-A Collegeville PA Rita Lehman, CPC-A Dallastown PA Donna Firn, CPC-A East Fallowfield PA Terri Brown, CPC-A Ellwood City PA Bonnie A Lorwey, CPC-A Enola PA

Vicky Whiteford, CPC-A Erie PA Patricia Rhoat, CPC-A Exton PA Rebekah Bueno, CPC-A Feasterville PA Maureen A Clarke, CPC-A Hatboro PA Megan Carpenter, CPC-P-A Havertown PA Alicia Marie Larock, CPC-A Hazleton PA Marylin Ott, CPC-A Holtwood PA Kathleen Ribera, CPC-A Hummelstown PA Hyun Gang, CPC-A Huntingdon Valley PA Kimberli Green, CPC-A Johnstown PA Tara Kathleen Erkinger, CPC-A Kleinfeltersville PA Farah Esther Blue, CPC-A Lancaster PA Joyce Frane, CPC-A Lancaster PA Alise Wolfe, CPC-A Lemoyne PA Lori Rose, CPC-A Levittown PA Cindy Boonie, CPC-A Mechanicsburg PA Pamela Erb, CPC-A Mertztown PA Amy Surdy, CPC-A Morrisville PA Tammy Nickel, CPC-A Mt Holly Springs PA Nanette M Sharpe, CPC-A New Cumberland PA Amanda Lehman, CPC-A Newmanstown PA Jacqueline Bonnie Rhodes, CPC-A Nottingham PA Jackie Mix, CPC-A Perkasie PA Jonathan Myatt, CPC-A Philadelphia PA Lorraine Riccio, CPC-A Philadelphia PA Anthony Shapit, CPC-A Philadelphia PA Maryann T Swain, CPC-A Philadelphia PA Mary Jane Blumen, CPC-A Pittsburgh PA Jennifer J Colarusso, CPC-A Pittston PA Marieliesa Kaye, CPC-A Quakertown PA Tina Marie Koewacich, CPC-A Sharon PA Judith A Reinfeld, CPC-A Shermansdale PA Linda Peters, CPC-A Slatington PA Jean Marie Sell, CPC-A Slatington PA Nicole Terese Colgan, CPC-A Stroudsburg PA Bethanne Foley, CPC-A Willow Grove PA Linda Montz, CPC-A Willow Grove PA Miriam S Hammond, CPC-A Windsor PA Nancy Rinehart, CPC-A York PA Melanie Bestwick, CPC-A West Warwick RI Roxanne Matthews, CPC-A West Warwick RI Brenda Annette Currence, CPC-A Clover SC Merriah Brock, CPC-A Graniteville SC Stephanie Necole Breazeal, CPC-A Greenville SC Sharonda M Durham, CPC-A Greenville SC Charlotte T Walker, CPC-A Laurens SC Elizabeth Jeanne Mitchell, CPC-A Moncks Corner SC Derryll Huiet Satterwhite, CPC-A Newberry SC Victoria Faye White, CPC-A Newberry SC Christina Gomez, CPC-A Ridgeland SC Carol Lee Waite, CPC-A Rock Hill SC Tawana Yvette Gadsden, CPC-A Summerville SC L'opici L'oreale Jones, CPC-A Winnsboro SC Darla Hope Simmons, CPC-A Woodruff SC Spencer Smith, CPC-A Sioux Falls SD Stephanie Suess, CPC-A Sioux Falls SD Nancy Vanderberg, CPC-A Sioux Falls SD S Sakthivel, CPC-H-A Thanjavur Tamil Nadu Colleen S Womack, CPC-A Chattanooga TN Kevin Jay Brown, CPC-A Cookeville TN Jennifer Carr, CPC-A Cookeville TN Courtney Marquez, CPC-A Cordova TN Linda Blaylock, CPC-A Cottontown TN Ashley Salter, CPC-A Gallatin TN Meghan Satterfield, CPC-A Gallatin TN Devra Dinsmore, CPC-A Georgetown TN Connie L Adams, CPC-A Harrison TN Teresa Diane Spence, CPC-A Hendersonville TN Sidra Duty, CPC-A Knoxville TN Kathryn Gabel, CPC-A Knoxville TN Lesli Marshall, CPC-A Lyles TN Charlene Mcclaran, CPC-A Maryville TN Deborah B Thomas, CPC-A Maryville TN Paulette Burgess, CPC-A Murfreesboro TN Annette Ward, CPC-A Piney Flats TN Lindsey Michelle Oneal, CPC-A Spring Hill TN Purnima Karnalkar, CPC-A Allen TX Gail Korbeck, CPC-A Allen TX Sonia Peoples-Morris, CPC-A Arlington TX Mary Ochoa, CPC-A Austin TX Melissa Maley, CPC-A Baytown TX Kiran N Gupta, CPC-A, CPC-H-A Brownsville TX Barbara Murley, CPC-A Cedar Park TX Celeste Burns, CPC-A Celeste TX Linda Pfleeger, CPC-H-A Clute TX Alesha Ann Lofton, CPC-A Dallas TX Sandra Washington, CPC-A Dallas TX Pinder Gill, CPC-A Frisco TX

Sherry Seibold, CPC-A Frisco TX John Conerly, CPC-A Ft Worth TX Nina Grey, CPC-A Ft Worth TX Lea Bradford, CPC-A Galveston TX Amber Edward, CPC-A Garland TX Talitha A Downing, CPC-A Gunter TX Jenilou Chua, CPC-A Houston TX Diana Foote, CPC-A Houston TX Catalina Jackson, CPC-A Houston TX Austin Mueller, CPC-A Houston TX Martha Johnson, CPC-A Humble TX Tammy Going, CPC-A Katy TX Sheila Raj, CPC-A Lewisville TX Latricia Jean Cole, CPC-A Mesquite TX Racine Reid, CPC-A Mesquite TX Lela E Cooper, CPC-A Milford TX Lindsay Renee Henkemeier, CPC-A Pasadena TX Kelly Salerno, CPC-A Pflugerville TX Gabriella Davis, CPC-A Plano TX Nancy Gier, CPC-A Plano TX Amina Jabbar, CPC-A Plano TX Shenul Jivraj, CPC-A Plano TX Jaymati Patel, CPC-A Plano TX Melinda Purdy, CPC-A Plano TX Susan Radford, CPC-A Plano TX Linda Skoglund, CPC-A Plano TX Luanne Aaron, CPC-A Quinlan TX Luzdary Kearns, CPC-A Rockwall TX Diana Pierini, CPC-A Round Rock TX Jennifer Dillon, CPC-A Royse City TX Jan Blackwell, CPC-A San Antonio TX Kristie Foster, CPC-A San Antonio TX Janet Fritz, CPC-A San Antonio TX Linda Johnson, CPC-A San Antonio TX Carol Klar, CPC-A San Antonio TX Jennifer Prieto, CPC-A San Antonio TX Susana Jaunita Rocha, CPC-A San Antonio TX Ann M Rubo, CPC-A San Antonio TX Frances Turner Tyler, CPC-A San Antonio TX Kimberly A Grimes, CPC-A Santa Fe TX Catherine Karas, CPC-A Southlake TX Sanober Ajani, CPC-A Sugar Land TX Marisol Robles-Castillo, CPC-A Texas City TX Stacy Harrison, CPC-A Blanding UT Jo Anne Petersen, CPC-A Brigham City UT Carla Miller, CPC-A Harrisville UT Chelsea Geer, CPC-A Ogden UT Stacey Marie Keyes, CPC-A Ogden UT Cynthia Martin, CPC-A Ogden UT Chantel Owens, CPC-A Riverton UT Susan Goodson, CPC-A Roy UT Heather Riddle, CPC-A Salt Lake City UT Adam Hegewald, CPC-A Sandy UT Rose Timmons, CPC-A South Jordan UT Melodee Marja Adams, CPC-A Taylorsville UT Donna Fox, CPC-A Washington UT Kathy Ann Miller, CPC-A West Jordan UT Darcel Wendt, CPC-A West Jordan UT Laurie Bronson, CPC-A Willard UT Dimple Sharma, CPC-A Arlington VA Nancy Mandas, CPC-A Ashland VA Agustin Jay Delarosa, CPC-A Chesapeake VA Kathryn Michalik, CPC-A Chester VA Angela West, CPC-A Chesterfield VA Mary Hall, CPC-A Daleville VA Nancy Myers, CPC-A Daleville VA Crystal Breen, CPC-A Edinburg VA Sharon Y Brooks, CPC-A Front Royal VA Ashley Dorothea McNeely, CPC-A Front Royal VA Nancy Tuel, CPC-A Front Royal VA Neetul Sharma, CPC-H-A Great Falls VA Deborah Kearnes Baumann, CPC-A Henrico VA Blair Abbott, CPC-A Kilmarnock VA Cecilia Fung, CPC-A Midlothian VA Margaret Clem Showman, CPC-A Mont Jackson VA Tawana S Stewart-McDuffie, CPC-A Portsmouth VA Songme Brill, CPC-A Richmond VA Susan Satterfield Burtoff, CPC-A Richmond VA Karen L Drader, CPC-A Richmond VA Bethany L Hankins, CPC-A Richmond VA Kimberly Harris, CPC-A Richmond VA Leisa C Harris, CPC-A Richmond VA Emily Murrell, CPC-A Richmond VA Connie Snead, CPC-A Richmond VA Maxine C Blue, CPC-A Ruther Glen VA Gina Hucal, CPC-A Springfield VA Daye Guertin, CPC-A Stuarts Draft VA Tricia A Bird, CPC-A Virginia Beach VA

Kimberly C Emig, CPC-A Virginia Beach VA Flora A Noble, CPC-A Virginia Beach VA Sandra Y Ortega, CPC-A Virginia Beach VA Rebecca King, CPC-A Waynesboro VA Daniry Gossens, CPC-A Burlington VT Ginger McDowell, CPC-H-A St Albans VT Keela Jacobson, CPC-A Battle Ground WA Randy Marrs, CPC-A Battle Ground WA Nicholas Bergeron, CPC-A Kent WA Marcia L Johns, CPC-A Olympia WA Jean Ann Hegyi, CPC-A Puyallup WA Geri Mishler, CPC-A Redmond WA Doug Nelson, CPC-A Sammamish WA Myra Walker-Sims, CPC-A Seattle WA Jaime Allen, CPC-A Vancouver WA Ronda Chagnon, CPC-A Vancouver WA Dina Glushenko, CPC-A Vancouver WA Kelly Jenkins, CPC-A Vancouver WA Margaret Skiles, CPC-A Vancouver WA Coral Towers, CPC-A Wenatchee WA Jessica Scow, CPC-A Arcadia WI Monica Vandenheuvel, CPC-A, CPMA Baraboo WI Rita Gabbard, CPC-A Coloma WI Kathleen Voss, CPC-A Middleton WI Selena Binns, CPC-A Milwaukee WI Carla Christophersen, CPC-A Milwaukee WI Jodi M Gerbig, CPC-A Pewaukee WI Rose Mary Phares, CPC-A Elkins WV Alyse Noelle Custer, CPC-A Fairmont WV Deborah L DeWitt, CPC-A Morgantown WV Melissa Gregg, CPC-A Rivesville WV Mary Peterson, CPC-A Cheyenne WY

Cynthia L Howerton, CPC, CGIC Gig Harbor WA Kathy M Walker, CPC, CPC-P, CEDC Vancouver WA Jumana Badani, CPC, CGSC, CUC Milwaukee WI Cindy L Gillespie, CPC, CEMC French Creek WV Jennifer Pfister, CPC, CHONC Sheridan WY

Magna Cum Laude

Lauren Lallone, CPC Birmingham AL Kurt Kevin Gordon, CPC-A Malvern AR Kathleen M Heren, CPC Peoria AZ Mei Ramsey, CPC Peoria AZ Priscilla Ducharme, CPC, CPC-H Phoenix AZ Charlotte Paige Edwards, CPC Sunland CA Elizabeth J Zaller, CPC-A Miami FL Beverly Sandra Ecklord, CPC-A Vero Beach FL Kim K Thomas, CPC-A Vero Beach FL Marie Cunningham, CPC-A Twin Falls ID Jennifer Connell, CPC Chicago IL Felicia Denise Merrell, CPC Chicago IL Malgorzata Mazurek, CPC-A Park Ridge IL Linda R Randecker, CPC-A, CPC-P-A Rockford IL Melissa Briar, CPC Greens Fork IN Annette Fischer, CPC-A Lexington KY Katie Reittinger, CPC Lexington KY Mary K Rude, CPC-A Versailles KY Sebrina Caudill, CPC-A Winchester KY Theresa M Frink, CPC Westfield MA Cassandra L Goddard, CPC Laurel MD Walter Fechner, CPC-A Ann Arbor MI Brenda Davis-Bauer, CPC-H Sterling Heights MI Karen Schad, CPC-A Lake St Louis MO Catherine Berg, CPC-A Pryor MT Amelia Davis, CPC-A Roxboro NC Margaret Clemson, CPC, CPC-H Sewell NJ Trisha Ann Wills, CPC-A Albuquerque NM Gina Spiezia, CPC-A Floral Park NY Christine de Leon, CPC Island Park NY Lisa Vickerson, CPC, CPC-H Troy NY Renee Shantery-Lawson, CPC-H Columbus OH Lauren Tress, CPC-A Corvallis OR Romaine Suminski, CPC Erie PA Ruth Broek, CPC-H, CIRCC Franklin TN Paola Jeanne Gates, CPC-A League City TX Tynan Montano, CPC-A Ogden UT Kimberly Ann Spiller, CPC Mechanicsville VA Teresa Baker, CPC Toano VA Christine Fairweather, CPC Woodbridge VA Julianne Lukana, CPC-A Gig Harbor WA Karen Kiritz, CPC-A Tacoma WA Kelly Carrier, CPC Hudson WI

Specialties

Carolyn Boston, CGIC Phoenix AE Shari L Cabaniss, CPRC Birmingham AL Carole Matter, CPC, CIMC Cullman AL Judy E Smith, CPC, CEMC Tucson AZ Carol Summers, CPC, CPCD Tucson AZ Ann Olivia Cardenas, CPC, CPEDC Perris CA Nicole L Kauffmann, CEMC, CFPC Santa Maria CA Deborah Ann Sammons, CPC, CEMC West Sacramento CA Khristin Diane Garrison, CPC, CHONC Pueblo CO Carrie A Applebaugh, CPC, COSC Bradenton FL Cynthia D Russo, CASCC Jacksonville FL Marcelo Torres, CPC, CPC-P, CENTC Miami FL Jennifer Jones, CPC, CANPC Conyers GA David Oliver, CENTC Savannah GA Sabra A Miles, CPC, CEMC Caldwell ID Nicole Reynolds Holstein, CPCD Carmel IN Carol A Costin, CPC, CPC-H, CEMC Fishers IN Stephanie Griffin, CCC Olathe KS Cindy Terry, CENTC Worcester MA Autumn M Gott, CPC, CCC Grand Rapids MI Rebecca H Lombard, CPC, CEMC St Louis MI Christine Steelman, CIMC Rolla MO Lynn Deaton, CPC, CPMA, CEMC Billings MT Debra Chastain, CPC, CEMC Charlotte NC Delores Roberson Everette, COBGC Tarboro NC Kylie Brooke Paces, CPC, CENTC Omaha NE Cynthia A Lamarche, CASCC Manchester NH Gabriel V Martinez, CUC Albuquerque NM Lori M Zigata, CPC, CCVTC Johnson City NY Patricia Diane Haley, CPC, CFPC Hilliard OH Dani Carr, CFPC Durant OK Patricia M Kidd, CPC, CGSC Albany OR Dolly Perrine, CPC, CPMA, CPC-I, CUC Bend OR Patricia A McCullough, CPC, CGSC Temple PA Christine Berman, CCC Wind Gap PA Dawn Phillips, CPC, CCC Dayton TX Kalene A Winslett, CFPC Denison TX Stella Crupko, CENTC Round Rock TX Ruth C Cambra, CPC, CASCC North Salt Lake UT Debra S Benson, CPC, CPMA, CCVTC, CGSC Stuarts Draft VA Joanne Carey Blanchard, CPC, CPEDC Winooski VT

www.aapc.com

October 2010

41

road map to ICD-10

Change With Our Coding Times

ICD-10-CM is happening, so be sure documentation is specific for this extensive code set.

By Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC

Change is inevitable, especially in the medical coding profession. There is a lot of talk going around about whether ICD-10-CM really will come to fruition. I talk to people in the medical coding and billing world every day and I am surprised at how many have no idea about ICD-10-CM. The ones who do know about it say, "Well, I'll believe it when I see it really happen." ICD-10-CM is happening and Oct. 1, 2013 is the day when it will be realized in the United States. Providers, payers and coders alike must prepare for this enormous transition. We all face learning totally new code sets with changing guidelines--going from 19 chapters to 21 chapters of guidelines. astatic (secondary) site(s) only, the metastatic site(s) is designated as the principal/first listed diagnosis. Code the primary malignancy as an additional code. 3) Malignant neoplasm in a pregnant patient Codes from chapter 15, Pregnancy, Childbirth, and the Puerperium, are always sequenced first on a medical record. First, use a code from subcategory O94.1 Malignant neoplasm complicating pregnancy, childbirth, and the puerperium, followed by the appropriate code from chapter 2 to indicate the type of neoplasm. 4) Encounter for complication associated with a neoplasm When an encounter is for management of a complication associated with a neoplasm, such as dehydration, and the treatment is only for the complication, code the complication first followed by the appropriate code(s) for the neoplasm. The exception to this guideline is anemia. When the admission/encounter is for management of anemia associated with the malignancy, and the treatment is for anemia only, sequence the appropriate code for the malignancy as the principal or first-listed diagnosis followed by code D63.0 Anemia in neoplastic disease. 5) Complication from surgical procedure for treatment of a neoplasm When an encounter is to treat a complication resulting from a surgical procedure performed to treat the neoplasm, designate the complication as the principal/first listed diagnosis. See guidelines for coding a current malignancy versus personal history to determine if the code for the neoplasm should also be assigned. 6) Pathologic fracture due to a neoplasm When an encounter is for a pathological fracture due to a neoplasm, and if the focus of treatment is the fracture, sequence a code from subcategory M84.5 Pathological fracture in neoplastic disease first, followed by the code for the neoplasm. If the focus of treatment is the neoplasm with an associated pathological fracture, first sequence the neoplasm code, followed by a code from M84.5 for the pathological fracture. The "code also" note at M84.5 provides this sequencing instruction.

Change With Our Coding Times

Review the New Guidelines

Chapter 2 still brings us Neoplasms, without too many changes. The ICD-10-CM Official Guidelines for Coding and Reporting 2010 (www.cms.gov/ICD10/Downloads/7_ Guidelines10cm2010.pdf) provides additional guidelines to assist with further specificity. Here are the new (excerpted) guidelines that coders must follow: j. Disseminated malignant neoplasm, unspecified Only use code C80.0 Disseminated malignant neoplasm, unspecified for those cases where the patient has advanced metastatic disease and no known primary or secondary sites are specified. Don't use it in place of assigning codes for the primary site and all known secondary sites. k. Malignant neoplasm without specification of site Code C80.1 Malignant neoplasm, unspecified equates to cancer, unspecified. Only use this code when no determination can be made as to the primary site of a malignancy. This code rarely should be used in the inpatient setting. l. Sequencing of neoplasm codes 1) Encounter for treatment of primary malignancy If the reason for the encounter is for treatment of a primary malignancy, assign the malignancy as the principal/first listed diagnosis. Sequence the primary site first, followed by any metastatic sites. 2) Encounter for treatment of secondary malignancy When an encounter is for a primary malignancy with metastasis, and treatment is directed toward the met-

Road Map to ICD-10-CM

42 AAPC Coding Edge

road map to ICD-10

m. Current malignancy versus personal history of malignancy When a primary malignancy is excised, but further treatment-- such as additional surgery for the malignancy, radiation therapy, or chemotherapy--is directed to that site, use the primary malignancy code until treatment is complete. When a primary malignancy previously is excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is no evidence of any existing primary malignancy, use a code from category Z85 Personal history of primary and secondary malignant neoplasm to indicate the former site of the malignancy. See Section I.C.21.4 Factors influencing health status and contact with health services, History (of). n. Leukemia in remission versus personal history of leukemia The categories for leukemia, and category C90 Multiple myeloma have codes for in remission. There are also codes Z85.6 Personal history of leukemia and Z85.79 Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues. Query the provider if the documentation is unclear as to whether the patient is in remission. See Section I.C.21.4, Factors influencing health status and contact with health services, History (of). o. Aftercare following surgery for neoplasm See Section I.C.21.7, Factors influencing health status and contact with health services, Aftercare. p. Follow-up care for completed treatment of a malignancy See Section I.C.21.8, Factors influencing health status and contact with health services, Follow-up. q. Prophylactic organ removal for prevention of malignancy See Section I.C.21.14, Factors influencing health status and contact with health services, Prophylactic organ removal. r. Malignant neoplasm associated with transplanted organ Code a malignant neoplasm of a transplanted organ as a transplant complication. Assign first the appropriate code from category T86 Complications of transplanted organ, followed by code C80.2 Malignant neoplasm associated with transplanted organ. Use an additional code for the specific malignancy. By comparing the differences with the specificity, you can realize what ICD-10-CM means to the future of coding. ICD-10-CM also will bring laterality to coding skin cancers, so physicians will need to document which side of a patient's body has skin cancer (e.g., documenting skin cancer on the right or left leg, or the right or left arm). If you don't have access to a draft of the new code set, AAPC has an online ICD-10-CM code translator on its website (www.aapc.com/ ICD-10/codes/index.aspx). This tool can help you and your practice assess where your provider's documentation may be lacking specificity to choose ICD-10-CM codes properly so you can accurately code their claims beginning Oct. 1, 2013. Contact dermatitis currently is reported as 692.9 regardless of if it is contact or allergic dermatitis, but with ICD-10-CM we need to have documentation to support more specific code descriptions: L23.9 Allergic contact dermatitis, unspecified cause L24.9 Irritant contact dermatitis, unspecified cause L25.9 Unspecified contact dermatitis, unspecified cause L30.8 Other specified dermatitis L30.9 Dermatitis, unspecified To support the ICD-10-CM equivalency codes for ICD-9-CM code 782.0 Disturbance of skin sensation you'll need documentation to support: R20.0 Anesthesia of skin R20.1 Hypoesthesia of skin R20.2 Paresthesia of skin R20.3 Hyperesthesia R20.8 Other disturbances of skin sensation R20.9 Unspecified disturbances of skin sensation

Revisit Medical Terminology and Anatomy

Specific supporting documentation helps better describe what is happening with the patient, but a clear understanding of medical terminology and anatomy is necessary to properly assign codes. Just as we continue to educate ourselves on yearly code changes, fee schedule changes, health care changes, and payer changes, even expert coders should consider taking a refresher course in terminology.

Precisely Describe the Dx

With the additional guidelines we can select more specific codes. Compare the description of the ICD-9-CM code with the following description of the ICD-10-CM code:

Dead-on Documentation Is a Must

Documentation, or lack of it, has always been a coder's nemesis. One of the goals of moving to ICD-10-CM is to avoid an "unspecified" diagnosis, when possible. Start now by showing your physician what documentation is necessary in the coming years. Take time to review ICD-10-CM codes and coding current superbills, charge tickets, and/or documentation. Challenge yourself to see what your practice can do to be ahead of the game that will commence Oct. 1, 2013. Don't be surprised if some of your payers require more information to support "unspecified" code selection. Continue to educate yourself and know AAPC will guide you all the way.

Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC, has over 20 years in coding and billing. Susan works for a plastic reconstructive surgeon in Phoenix. She also teaches CPC® classes locally, is a webinar and workshop presenter for AAPC, and is an ICD-10 trainer.

ICD-9-CM

Carcinoma skin of breast Carcinoma skin of chest Melanoma InSitu skin of cheek Carcinoma InSitu skin of cheek Carcinoma skin of nose

173.5 173.5 172.3 232.3 173.3

ICD-10-CM

C44.52 C44.59 D03.39 D04.39 C44.31

www.aapc.com

October 2010

43

hot topic

Vaccine Administration, Simplified expertise Boost your immunization

By G. John Verhovshek, MA, CPC

codes when necessary (for instance, for two or more subsequent administrations). Like the initial administration codes, these codes also are differentiated by route of administration, the age of the patient, and whether the physician provides counseling during the same session. Use these decision grids to aid in code selection for subsequent administrations:

Subsequent administration by percutaneous, intradermal, subcutaneous, or intramuscular injections

PROFESSIONAL

he April 2010 Coding Edge article, "Don't Let Vaccines Poke Holes in Your Practice's Pockets," generated numerous reader responses, several of which appeared in "Letters to the Editor" in later months. The article and subsequent responses continue to elicit reader comments. Here is a follow-up to provide additional, specific information and clarification for coding immunization administration. When reporting immunization administration for vaccines or toxoids (CPT® 90465-+90474), you may report only one initial administration code. CPT® defines the initial administration as the first vaccine administered to a patient during a single patient encounter. Which code you select depends on the route of administration, the age of the patient, and whether the physician provides counseling during the same session. Consider these decision grids to aid in code selection for the initial administration:

Initial administration by percutaneous, intradermal, subcutaneous, or intramuscular injections

T

with physician counseling Patient age younger than 8 years Patient age 8 years or older

+90466 +90472*

w/o physician counseling

+90472 +90472

* Account for counseling as part of any separately-reported E/M service

Subsequent intranasal or oral administration

with physician counseling Patient age younger than 8 years Patient age 8 years or older

90465 90471*

w/o physician counseling

90471 90471

with physician counseling Patient age younger than 8 years Patient age 8 years or older

+90468 +90474*

w/o physician counseling

+90474 +90474

* Account for counseling as part of any separately-reported E/M service

Initial intranasal or oral administration

* Account for counseling as part of any separately-reported E/M service

Coding Dissimilar Administrations

with physician counseling w/o physician counseling

90473 90473

Patient age younger than 8 years Patient age 8 years or older

90467 90473*

* Account for counseling as part of any separately-reported E/M service

Report subsequent administrations, beyond the initial administration, using add-on codes. You may report multiple units of these 44 AAPC Coding Edge

If more than one type of administration is received by the same patient during the same encounter, you may code either encounter as the initial administration. Recalling CPT® instruction, however, you may not report more than one initial administration per encounter. For example, suppose after receiving physician counseling a 7-yearold patient receives two vaccines--one by injection and another orally. In this case, you may report either 90465 Immunization administration under 8 years of age (includes percutaneous, intradermal,

hot topic

subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day or 90467 Immunization administration under age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day as the initial administration. You may not report both. If you report the injection as the initial administration (90465), you must report the oral administration as subsequent (+90468 Immunization administration under age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/ family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)). Equally as valid, you may report the oral administration as initial (90467), and report the injection as subsequent (90466 Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)). Tip: Although you may choose either route as the initial administration, the initial injection codes (90467, 90471) are valued slightly higher than the initial oral/intranasal codes (90467, 90473). It is in your best financial interest always to report the injection administration as initial if both an injection and oral/intranasal administration are provided.

If physician counseling does not occur, regardless of the patient's age and depending on the route of administration, you must select an initial administration code:

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, and intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

And subsequent administration codes:

+90472 Immunization administration (includes

percutaneous, intradermal, subcutaneous, and intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

+90474 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Pediatric Codes Require Physician Counseling

Note that pediatric administration codes (those for children younger than 8 years of age), 90465-+90468, require physician counseling. Although clinical staff, such as a nurse, may provide the actual administration, a physician (generally defined by Medicare as a doctor of medicine or osteopathy) must provide the counseling. Such counseling may include a review of the risks and benefits of all vaccines, discussions of previous vaccine reactions, the impact of any new illness, and possible contraindications to the vaccine. Documentation should reflect that this counseling occurred.

Note: An exception to the above rule may apply when an advanced practice nurse performs the face-to-face vaccine counseling incident-to a physician. For additional information, view the American Academy of Pediatrics (AAP) website at: www.pcc.com/ pub/pm/docs/AAP-immsadmin.pdf. Keep in mind that physician counseling also may occur for patients age 8 years or older. CPT® does not include a single code to describe these services specifically. Rather, you'd report the non-pediatric codes (90471-+90474), along with an appropriate evaluation and management (E/M) service code to describe the counseling. CPT® rules allow reporting E/M services by time if more than 50 percent of the service time is dedicated to counseling (or coordination of care). Documentation should verify that the physician provided counseling, and detail the content and extent of that counseling, to support separate billing of the E/M service. In addition, you should append modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service to the appropriate E/M code.

+90474). The AAP specifically addresses this issue, noting, "Using codes from both families would be an uncommon event ... This might happen if the patient is receiving a vaccine that is new to them and a `repeat' vaccine (eg, the third hepatitis B vaccine in the series). The physician may provide vaccine counseling on the new vaccine (and report a code from the 9046590468 code family) but not on the repeat vaccine (and report a code from the 9047190474 code family)." Be aware, however, CPT® provides parenthetical notes that direct coders to apply counseling codes only with other counseling codes, and non-counseling codes only with other non-counseling codes. For example, a note following +90466 directs, Use 90466 in conjunction with 90465 or 90467. Coding edit software programs--(such as the National Correct Coding Initiative (NCCI))--may disallow reporting counseling and non-counseling codes together.

Report Vaccines, Toxoids Separately

Vaccine and/or toxoid administration does not include the actual vaccine or toxoid itself, which may be reported separately from CPT® 90476-90479. The AAP provides the following example at the same location referenced above: A 9-year-old patient receives her second measles, mumps, and rubella (MMR) vaccine and her third hepatitis B vaccine. The physician conducts the vaccine counseling associated with both vaccines. The immunization administration for this visit is reported as follows:

90707 MMR vaccine, live, for subcutaneous use 90471 (initial administration) 90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use 90472 (subsequent administration)

Mix Counseling, Non-counseling Codes With Caution

Typically, you would not combine the codes that include physician counseling (90565+90468) with those that do not (90471-

The AAP explains that although the physician does conduct the vaccine counseling, the patient is over 8 years of age. As such, immunization administration codes from the 90471-90474 code family are reported. E/M, or any other services provided during the encounter, is reported separately.

[

G. John Verhovshek, MA, CPC, is director of editorial development/managing editor at AAPC.

]

45

www.aapc.com

October 2010

facility

Ochsner Health System

An ongoing commitment to aspiring medical coders proves to be a rewarding innovation.

By George Dansker, MPH, MLIS, CPC-A

Ventures a Coding Internship Program

I

APPRENTICE

n 2009, the coding and education department of Ochsner Health Systems developed and implemented an internship program geared exclusively for medical coders. This six-month program was created as part of Ochsner's ongoing commitment to train and develop aspiring medical coders. It was designed to give the coding and education departments the potential to hire well-trained employees who already know a great deal about Ochsner computer and billing systems and processes. The program is geared specifically for individuals who have taken formal coding courses; however, it is not required that any student already have the Certified Professional Coder (CPC®) credential. Kim Guichard, CPC, CPAT, CCAT, coding education manager for Ochsner Health Systems, describes the program as something that was developed to provide the student with "the education and training to become a knowledgeable and confident coder." This development of confidence is important not only for the coder, but it also increases the confidence level for department managers in regards to the professional skill of the new employee. Fortunately, the department already had on board a team of six coding educators. The education team, along with department managers, created a detailed course syllabus that includes thorough training in the proprietary online systems at Ochsner, as well as comprehensive training in Medicaid and Medicare regulations, Medicare risk adjustment, modifiers, anesthesia, evaluation and management (E/M) auditing, and various commercial software programs such as 3MTM and Ingenix®. The beauty of the system is various department staff are tapped for their expertise to teach particular components of the program. It is not necessary to import outside faculty; each coding educator can teach a class(es) in her particular specialty, and the other staff members are brought in to teach specific online systems and other components of the training program. The students and teachers use a classroom in the restored Ochsner Baptist facility, in the uptown section of New Orleans not far from the main campus on Jefferson Highway. This classroom setting provides an ideal envi-

ronment for hands-on learning (all necessary software programs and systems are available), as well as a traditional lecture environment and one-on-one instruction. Coding educator Christine Daigle, CPC, an original member of the teaching team, is quick to emphasize the importance to the program and the students of the computer training in many medical specialty areas. In addition to their classroom time, coding interns begin actual coding almost right away, thereby adding to the overall productivity of the department. The interns also attend departmental meetings, and are encouraged to attend AAPC local chapter meetings. Approximately the first three months of the program consist of a structured class schedule focusing on the Ochsner systems. After that, the emphasis is on actual supervised "real time" coding-- although classroom lessons, review sessions, and new learning experiences are still a part of the curriculum. The coding interns receive an hourly salary and benefits. For those who already have the CPC-A® the program counts as six months experience toward removal of the apprenticeship status.

Excited Coding Educators Speak Up

Coding educator Myra Anderson, CPC, describes the program as, "Exceptional ... unlike any other I know of." She adds, "The small classes make educating and getting to know people and their work habits and how they work with others very easy." While commenting also on the uniqueness of the program, coding educator Theresa Hays, CPC, CCAT, is happy that it gives her, "the opportunity to combine the two things most enjoyed--coding and teaching." Coding educator Maria Tran, CPC, CCAT, agrees that the benefits are two-fold for educators: "It is a pleasure to teach something that we are passionate about to a group of people who are eager to learn!" Angela Clements, CPC-COSC, CCAT, CPAT, another member of the coding education team, feels the program can help eliminate frustration for those who have taken classes and cannot find a job due to lack of experience--something she hears about first hand

46 AAPC Coding Edge

facility

The coding interns receive an hourly salary and benefits. For those who already have the CPC-A®, the program counts as six months experience toward removal of the apprenticeship status.

as an AAPC local chapter officer. Clements states the program "gives [the students] an opportunity to try out employment with Ochsner and decide if it is the place of employment for them and also allows us the same opportunity. Another plus factor: The interns get to code in multiple specialties so they more easily can find their comfort zone or the specialty that interests them the most." Marilyn Choppin, CPC, CCAT, a coding educator with extensive experience in orthopedics and ophthalmology, has found the program to be both "rewarding and challenging." Even if there were occasional disappointments, she never would have opted out. The coding interns have truly benefited from Ms. Choppin's detailed knowledge of the disease processes affecting our vision and the procedures helping to improve it. The program has gained popularity since the first coding intern class in 2009, which had five students. Upon completion of their coursework, all interns were hired for coding positions throughout the Ochsner system. For the 2010 program, there were one hundred applicants, and six students were chosen after an extensive interview process. out of a coding program, and hadn't gotten any real world experience yet. Gaining a coding position is not always easy after school, because a lot of jobs want experience in the field. This program allows entry level coders to gain the experience they need in order to meet the criteria to secure the position they are looking for." Kim Morales, CPC, an outpatient coder specializing in emergency department (ED) coding, was also a graduate of the 2009 class. She is appreciative particularly of having been exposed to a variety of specialties and the wealth of knowledge that each educator brought to the program. Morales noted, "The small size of the class allowed for individualized training which was also very beneficial."

Consider Starting a "Win-Win" Intern Program

The program has "far exceeded" the expectations of Ochsner's Director of Hospital and Physician Coding and Education Brian A. Audler, CPC, CCAT, CPAT. He is very pleased with the program because "There are a tremendous amount of new professionals in the industry who just need that initial opportunity to show what they can do. This internship program does just that." Audler added, "The coders get the opportunity to obtain an entry level position with the opportunity for advancement in only a six month period and they are well positioned for success within our department. This is a perfect jumpstart to a career. Something which I think we would all like to have had once our formal coding training was completed." Let's hope other teaching and research hospitals will consider this option for their medical coding departments. A program like this expands the internship component of AAPC certification. For the Ochsner Health Systems' coding and education department, this truly has been a "win-win" situation. Preparation has begun to start a new group of coding interns for early 2011. We look forward to teaching these aspiring coders.

Students Rave About Their Experience

Mary Galjour, CPC-A, CCS, recent graduate, is enthusiastic about the tremendous experience she has achieved with coding educators: "Experience is always the best teacher ... when I think of the experience of the coders that were my `educators,' I realized that I have had the benefit of over fifty years of experience, all in a sixmonth period. I am truly lucky to have been able to be a part of this coding internship." Another 2010 student, Tammy Keppler, is equally enthusiastic about the program, saying, "The program is great; I love my fellow interns and educators. We are learning much in class, ... [it] truly sheds some light on how the whole system works and I appreciate the opportunity that I have been given. I am very excited for the day I can become a certified coder." The students from the first class (2009) also have positive recollections about their participation in the program, as well. Danielle N. Goldsberry, CPC-A, CCA, now employed as an outpatient coder at Ochsner in Nephrology, describes the program as "extremely helpful in getting practical coding skills ... because I had just gotten

George Dansker, MPH, MLIS, CPC-A, is an outpatient coder specializing in MRA for coding and education at Ochsner Health System.

www.aapc.com

October 2010

47

AAPCCA

Chapters: Host Exams Before Year-end

Year-end exams enable members to test before 2011 codes changes take effect.

By Lynn Ring, CPC, CPC-I, CCS, CCS-P

O

ctober, November, and December are three of the more popular months during which members take certification exams. One of the main reasons for this trend is that members want to sit for the certification exam before the new year ushers in 2011 certification exams with 2011 CPT® code changes.

Year-End Mad Dash for Certification

For members who have studied for the past several months, being able to take the exam in 2010 will make a huge difference in their final score. Their books have their handwritten notes and most examinees are more comfortable with the books they have worked with all year. Taking the certification exam with any books outside of the current year puts members at an extreme disadvantage. Having end-of-year exam options is a tremendous relief to those who want to test before the books change.

bigger room for your last exam of the year, opening up more seats to members. Sit down with your new officers, plan the exam schedule for next year, and get that schedule to AAPC to approve and publish so it is posted early. Members who aren't able to schedule their exam until after the holidays will be looking for exam sites soon after Jan. 2.

Help Coders Get Certified

As local chapters, it's our mission to support AAPC and our members. Per the Local Chapter Handbook, chapters are required to offer a minimum of four exams a year-- but why settle for the minimum? Adding an additional exam date or two--especially in the last quarter of the year--provides opportunities for more members to achieve their goal of becoming a Certified Professional Coder (CPC®). What a statement to our profession that so many are seeking to become certified coders. What an honor to help promote this profession. Isn't that why we're local chapter members? Isn't that why we're certified coders? Let's get moving and schedule those year-end exams to accommodate our members who want to become certified in 2010.

Lynn Ring, CPC, CPC-I, CCS, CCS-P, a member of the AAPCCA Board of Directors, has more than 30 years of medical coding and billing experience. She has been involved in every aspect of coding from statistics and research to reimbursement and compliance. She has been a PMCC instructor since 2002 and has taught and certified countless new coders. With a recent move to Tampa, Fla. she is starting anew with coding, billing, and compliance for Moffitt Cancer Center with over 250 providers.

Incoming Officers Can Get a Jumpstart

In addition to helping members, a year-end exam is the perfect opportunity to mentor your chapter's newly elected officers, who must schedule exams for 2011. As the year's end nears, incoming chapter officers are eager to get started but may not know where to begin. This is a good time for 2010 officers to mentor incoming 2011 officers by including them in the chapter's plans for ending the current year and beginning 2011. (To find out more about how to mentor incoming officers, read the accompanying article "Mentor Tomorrow's Chapter Leaders.") Line up proctors and get your exam scheduled. If additional testing dates are not possible, consider reserving a 48 AAPC Coding Edge

AAPCCA

Mentor Tomorrow's Chapter Leaders

By Claire Bartkewicz, CPC-H

Promote, guide, and foster leadership to lighten the load of future officers.

E

lection time can be both exciting and stressful for chapter officers. It's exciting because current chapter officers are preparing a new group of volunteers for leadership roles and stressful because many times the volunteers are few and far between. This dilemma can occur year after year if proper preparation is not made. Potential officers often hold back because they don't fully understand what will be required of them. Mentoring may be the answer. Mentoring is spoken of often, but may not be understood fully. Simply put, a mentor is an experienced person who helps someone less experienced. Some fall naturally into the role of adviser or counselor, and they can be found among your members.

Look to Experienced Members for Guidance

Past officers are a wonderful resource for guiding interested members towards chapter leadership. They have experience and knowledge and enjoy sharing it. Long time members also are a great source of information and have an understanding of what makes the chapter work best. Current officers can "find their replacement" for the next year by connecting with members. It's an opportunity to discover the hidden talents of someone who, with a little encouragement, could do a great job.

Promote Officer Benefits

One of the best ways to promote interest in being an officer is to make sure the benefits are well known. Although being an officer may be time consuming, there are so many rewards. Here are just a few: · Increased confidence and knowledge · Improved networking · A nice addition to your resume · A discount to the AAPC National Conference More importantly, it gives you a chance to guide your chapter in new directions and enhance members' experience.

· Plan a workshop or seminar and ask for volunteers. Volunteers can pair up with officers and get a feel for what it takes to do that job. · Try a networking exercise that pairs up established members with new ones. The more comfortable members feel in your chapter, the easier it is to step up to help. · Hold a chapter meeting focusing on the roles and responsibilities of officers. Cover necessary communication and management skills. (Continuing education units (CEUs) should be covered under Related Core B Curriculum.) · Use monthly meetings to "grow" volunteers: Start committees to set up, clean up, run the sign-in table, and welcome members. Anything that gets members involved works. · Share pieces of your chapter "responsibilities." Many hands make the burden lighter and your mentoring can benefit not only one member, but the entire chapter. · Host a roundtable event to discuss multiple topics. Smaller groups encourage interaction and bolster confidence. · New member development officers have a great opportunity to introduce neophytes to the chapter. Don't miss out on this one. · Help new officers by having a friendly meeting with past officers to discuss any problems or concerns they have. · Have an open enrollment. Send an e-mail blast to all members requesting nominations for next year's officers. Let them know "It's okay to nominate yourself." You may be surprised at the response! The most important thing you can do is let potential candidates know they will have the support of past officers and wonderful assistance from the Local Chapter Department in the national office. Assure candidates they will not be alone. Mentoring is a cooperative experience between like minded individuals and your chapter is a perfect setting. Each potential officer brings singular talents to the table; and with a little encouragement, we will all see the benefits of their contributions.

Claire Bartkewicz, CPC-H, a member of the AAPCCA Board of Directors, has worked at Bayshore Community Hospital for 25 years. She started as patient registrar in the emergency department (ED) and was a novice to medical terminology. Claire attended her first coding class when CPT® was in its infancy. Her registration background helps her to manage the revenue cycles of outpatient coding and reimbursement. Claire is co-founder of the New Jersey Coding and Billing Conference.

There Is More Than One Way to Mentor

Mentoring is something that can be done incrementally. It isn't necessary to dedicate huge blocks of time to prepare someone for future office. Some suggestions:

www.aapc.com

October 2010

49

Need CEUs

2009 & 2010 Annual CEU Coding Scenarios are approved by the AAPC for CEUs! 6.5 - 10.5 CEUs per course

Over 125 Approved CEUs starting from $30 Topics Include: Anatomy / Med Term Auditing / RAC ICD-9 and ICD-10 Specialty Coding E/M and OB/GYN Interventional Radiology Reimbursement ...and more CodingWebU.com is the leading provider of online education geared towards Medical Coding and Billing.

CodingWebU.com

TM

Providing Quality Education at Affordable Prices

(484) 433-0495 www.CodingWebU.com

It's what's on the INSIDE that matters in ICD-10

Get the new Advanced Anatomy and Physiology for ICD-10 book today!

Advanced Anatomy and Physiology for ICD-10 provides the in-depth information you need to prepare for the most dramatic change in coding ever:

Detailed review of each body system ­ with in-depth information on cells, tissues, and organs that comprise each body system Clarifies the new anatomical and physiological documentation requirements ­ for code capture in ICD-10-CM and ICD-10-PCS Quizzes at the end of every chapter ­assists in testing your knowledge on what you have just learned Detailed, full-page anatomy illustrations plus code-specific illustrations that have been integrated into the book ­ allows better interpretation of clinical notes to help code with more specificity Extra help on new, revised and deleted codes ­ unique symbols identify new procedure codes and substantially altered procedure descriptions alert you to changes in the ICD-10 code sets And much more...

Call us today at 1-800-334-5724 and mention promo code APCE910 Order online at www.codingbooks.com/api and enter promo code APCE910

Contexo Media P.O. Box 25128 SLC, UT 84125-0128 FAX 801.365.0710 PHONE 800.334.5724 ONLINE www.codingbooks.com/api

17780

NAMAS

2nd ANNUAL AUDITING CONFERENCE

December 6 and 7, 2010

A Subsidiary of DoctorsManagement

WHERE

SPEAKERS

Deborah Grider, AAPC President & CEO, Key Note Speaker Shelton Hager, MD, Key Note Speaker Shannon Smith (DeConda), Founder of NAMAS/ Coding & Auditing Dept. Director Rhonda Burkholtz, AAPC Vice President, Business Development Kevin Townsend, NAMAS Instructor/ Consultant Melody Irvine, NAMAS Instructor/ Consultant Paula Wright, NAMAS Instructor/ Physician Educator Theresa Powers, Coding & Billing Department Head

*Credentials of speakers along with their biographies may be found on our website.

Grove Park Inn Resort & Spa 290 Macon Ave, Asheville, NC 28804 866-474-4953 www.groveparkinn.com Special Room Rate - $129

The convention will be 2 days of educational sessions. We will cover the following:

Specialty Options

Radiology / Interventional Radiology Teaching Physicians Ophthalmology Interventional Cardiology General Surgery Pediatrics / Internal Med / Family Med Psychology

RESERVE NOW

The price for the convention is $895 for non-AAPC members and $795 for AAPC members.

Early Bird Special -- sign up by Sept 30, 2010 and receive

Dinner at the Biltmore, including transportation to and from, along with a two hour Christmas candlelight tour of the Biltmore.

General Auditing

E / M Auditing Compliance Diagnosis Auditing Hands on Auditing Auditing From The Physician's Point of View Marketing Yourself See our website for complete schedule

· Includes breakfast, lunch and breaks · Earn up to 14 CPMA Specific CEU's · Includes a conference book

Transportation to and from the Airport is available at an additional cost.

visit www.NAMAS-Auditing.com

CEUs - 14 CPMA Specific AAPC Approved

877-418-5564

Information

52 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

61925

You might also be interested in

BETA
TH1206WEB.qxd