Let Anywhere Be Your Office

56 Pages·2009·4.24 MB·English

January 2010
Let Anywhere
Be Your Office
Melody S. Irvine,
CPC, CEMC, CPC-I,
CCS-P, CPMA, CMRS,
Loveland, Colo.
Plus: Out-of-Network Claims • Consult Confusion • Facility Infusions • Catheter Placement • CDIP, MCC, CC, HCC
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CodingWebU.com
Providing Quality Education at Affordable Prices
[phone] www.CodingWebU.com
contents
14 20 50
January 2010
[contents]
In Every Issue
5 Letter from the President
6 Letters to the Editor
7 Letter from Member Leadership
54 Coding News
8 Education
Features 12 New Auditing Credentials
Rhonda Buckholtz, CPC, CPC-I, CPC, CPC-I,
CENTC, CGSC, COBGC, CPEDC
8 Start Your Own Business
Melody S. Irvine, CPC, CEMC, CPC-I, CCS-P, CPMA, CMRS
Online Test Yourself – Earn 1 CEU
14 CDIP, MCC, CC, HCC: The Road to Better Revenue go to www.aapc.com
Nancy Reading RN, BS, CPC, CPC-I
18 Make the Most of Out-of-Network Claims People
Kathy Philp, CPC, and
Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC
25 AAPCCA
20 Facility Infusions: Free the Confusion
Sarah L. Goodman, MBA, CPC-H, CCP, FCS
42 Newly Credentialed Members
22 Catheter Placement is Critical to Coding Arterial System Procedures
David B. Dunn, MD, FACS, CIRCC, CCS, CCC, CPC-H, RCC
49 Minute With a Member
32 Examine the 2010 OIG Workplan
Jillian Harrington, MHA, CPC, CPC-I, CCS-P
34 2010 OPPS Finalized
Denise Williams, RN, CPC-H
38 Know Group Practice Liability Under the FCA
Coming Up
Michael D. Miscoe, JD, CPC, CASCC, CUC, CHCC
46 Brace Yourself for Change: CMS Says No More Consults
Time-based E/M
Suzan Berman, CPC, CEMC, CEDC
Modifiers 26/TC
50 10 Common Physician to Hospital Job Transition Challenges
Dorothy Steed, CPC-H, CHCC, CPC-I, CPUM, CPUR, CPHM, CCS-P, CEMC, Hospital-side OIG Workplan
CFPC, ACS-OP, RCC, RMC, PCS, FCS, CPAR
Initial Chiro Visit
On the Cover: Experienced entrepreneur, Melody S. Irvine, CPC, CEMC, CPC-I,
CCS-P, CPMA, CMRS, takes multitasking to a new level while she realizes her dream Payer Perspective
of owning a business in Loveland, Colo.
Cover photo by Warren Diggles (www.warrendiggles.com).
www.aapc.com January 2010 3
Serving 85,000 Members – Including You
Targeting the AAPC Audience
January 2010
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
CEO and President
every issue we will publish at least one article on each of three levels: apprentice,
Reed E. Pew
professional and expert. The articles will be identified with a small bar denoting [email protected]
knowledge level: Vice President of Clinical Coding Content
Sheri Poe Bernard, CPC, CPC-H, CPC-P
Beginning coding with common technologies, basic anatomy and
APPRENTICE physiology, and using standard code guidelines and regulations. [email protected]
Vice President of Strategic Development
More sophisticated issues including code sequencing, modifier Deborah Grider,
PROFESSIONAL use, and new technologies. CPC, CPC-I, CPC-H, CPC-P, COBGC, CEMC, CPCD, CCS-P
[email protected]
Advanced anatomy and physiology, procedures and disorders Vice President of Marketing
EXPERT for which codes or official rules do not exist, appeals, and payer Bevan Erickson
specific variables. [email protected]
Vice President, Business and Member Relations
Rhonda Buckholtz, CPC, CPC-I, CGSC, CPEDC, COBGC, CENTC
[email protected]
Vice President of Product Management
David Maxwell
x
American Society of Health [email protected]
e
d Informatics Managers ..........................p. 17 Director of Coding Communications
n www.ashim.org John Verhovshek, MA, CPC
i [email protected]

g Catamount Associates .........................p. 24 Director of Member Services
n
http://catamountassociates.com/ Danielle Montgomery
i
s [email protected]
i
t The Coding Institute Director of Publications
r
e CodingCert.com ............................p. 37 Brad Ericson, MPC, CPC, COSC
v www.CodingCert.com [email protected]
d Coding Conferences LLC Senior Editors
a
www.CodingConferences.com Michelle A. Dick, BS Renee Dustman, BS
[email protected] [email protected]
CodingWebU .........................................p. 2 Production Artist
www.CodingWebU.com Tina M. Smith, AAS Graphics
[email protected]
Contexo Media .....................................p. 45 Display Advertising
www.codingbooks.com Jamie Zayach, BS
[email protected]
Address all inquires, contributions and
HeathcareBusinessOffice LLC .............p. 25
change of address notices to:
www.healthcarebusinessoffice.com
Coding Edge
Ingenix ..................................................p. 55 PO Box 704004
www.shopingenix.com Salt Lake City, UT 84170
(800) 626-CODE (2633)
Inhealthcare, LLC ................................p. 31 © 2009 American Academy of Professional Coders, Coding Edge. All rights reserved.
www.supercoder.com 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
American Academy of Professional Coders. Statements of fact or opinion are the respon-
Medical Compliance Training .............p. 53
sibility of the authors alone and do not represent an opinion of the AAPC, or sponsoring
www.medicalcompliancetraining.com organizations. Current Procedural Terminology (CPT®) is copyright 2009 American Medical
Association. All Rights Reserved. No fee schedules, basic units, relative values or related
Medco Consultants, Inc. ......................p. 31 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 the
www.medcoconsultants.com
American Academy of Professional Coders.
NAMAS/DoctorsManagement .............p. 56
Volume 21 Number 01 January 1, 2010
www.drsmgmt.com
Coding Edge (ISSN: 1941-5036) is published monthly by the American Academy of Professional Coders,
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
Trust Brings Value
It’s a new year, a new beginning. Like most,
you probably closed out the old year by
reflecting on what kind of year you had and
by considering your accomplishments and/
or regrets. Hopefully, you spent quality time
with friends and family and took time to
count your blessings. What’s next?
To start with, you might consider what you
can do to make your place of employment
more successful. In the process, you’ll prove
your worth in the workplace and earn your
employer’s appreciation—always a good
thing! To get the ball rolling, consider the
following observations (keeping in mind
that you may need to adapt them to your
particular place of employment).
Money Talks
In health care, it’s about the money. The
reason I know it must be about the money
is because there are so many articles where
everyone say it’s not about the money. A
recent survey I read said that among the top
10 worries physicians had about their prac-
tice, seven were about finances or money.
So, how can you can help employers be hap-
pier? Apparently by helping them make
more money and reducing their financial
stress. Look around. See where operations Improve Workflow to know that you, as a coder, can help. By
are inefficient or where time could be better creating a solution, you can gain more trust.
I’ve long felt that coders and billers should be
spent in clinical work that is currently If your idea is rejected, consider why:
the same person. Communication problems
being spent in administrative work. When
would be reduced and claim issues would be  Were the benefits of the solution stated well?
making suggestions for improvement, be
corrected more easily. I think its easier for me  Was it quantified in any way?
assertive but not overbearing. Properly think
to communicate with me than with others.
out suggestions. Good solutions don’t cost  Was the solution easy to understand?
Think of ways to eliminate wasted time spent
an arm or leg. Obvious solutions make for Most employers, myself included, can determine
processing claims. If your electronic medical
easy decisions. Questions that can help solve if a solution is good within just a few minutes.
record (EMR) system doesn’t work efficiently,
financial worries are:
you should look to streamline claims process- Earn Trust
 How can claims be sent more quickly? ing by asking yourself:
Coders know a lot! I know you know much
 How might denials be reduced or  Are there limitations to your EMR system caus- more than coding. Use your knowledge
followed up faster? ing major glitches in workflow?
of the entire practice or facility, including
 How can we better understand each payer’s rules?  Do some personnel not know the EMR system well? payer rules, denial issues, EMR issues and
If your physicians do a lot of their own Ask to be the trainer and have weekly 30 more, to gain the trust of your employer.
coding and you, frankly, can do it better, minute training sessions. Every Friday Once you earn your employer’s trust, you
tell them. Most physicians hate coding. afternoon at the AAPC, for example, we will always be of value.
Many coders feel doctors won’t listen have one hour training in a specific area for
Sincerely,
to them. That may be true in limited all employees.
instances; however, most physicians will If people are overloaded at work or there is a
listen, especially if it improves their bottom bottleneck in the process, think about how Reed E. Pew
line or gives them more family time. to solve that. Assertively tell whoever needs CEO and President
www.aapc.com January 2010 5
Please send your letters to the editor to:
[email protected].
Letters to the Editor
Know PA and NP Rules on Direct Medicare Billing payers, and not just Medicare. There always seems to be an issue when coding
screening colonoscopies, for instance. Please be sure your coders are aware of this
“Maintain NPP Reimbursement, Improve Practice Productivity” (Coding Edge
requirement mandated by HIPAA.
September 2009) states that Medicare permits NPs (nurse practitioners) to bill
the Medicare program directly, but that PAs (physician assistants) may not bill Vera White, RHIT, CCS
Medicare directly (page 25). Was the author referring only to hospital billing?
You are absolutely correct: The Official ICD-9-CM Guidelines for
As I understand, Medicare will allow PAs to bill directly in an office setting.
Coding and Reporting is an inclusive part of the code set mandated by
Please clarify how place of service (POS) affects a PA’s ability to bill Medicare.
all payers, whether Medicare or third-party private insurers, under the
Joanne Kent-Veglia Health Insurance Portability and Accountability Act (HIPAA). For
additional information, see “ICD-9-CM Official Guidelines are Part of
The advice “PAs may not bill their services directly to Medicare” was a
the Code Set,” Coding Edge, September 2009, page 9.
reference to Medicare’s Benefit Policy Manual, section 190.D, which states:
Regarding the specific example of appropriate ICD-9-CM coding for
Payment for the services of a PA may be made only to the actual
screening colonoscopy: The official guidelines stipulate, “A screening
qualified employer of the PA that is eligible to enroll in the Medicare
code may be a first-listed code if the reason for the visit is specifically
program under existing Medicare provider/supplier categories. If the
the screening exam … Should a condition be discovered during the
employer of the PA is a professional corporation or other duly qualified
screening, then the code for the condition may be assigned as an addi-
legal entity (such as a limited liability company or a limited liability
tional diagnosis.”
partnership), properly formed, authorized and licensed under State
laws and regulations, that permits PA ownership in such corporation For several years, however, the Centers for Medicare & Medicaid Ser-
or entity as a stockholder or member, that corporation or entity as the vices’ (CMS’) guidance on this issue was unclear, leaving the impres-
employer may bill for PA services even if a PA is a stockholder or offi- sion that if a condition was discovered during a screening colonoscopy,
cer of the entity, as long as the entity is entitled to enroll as a “provider the condition (rather than the screening code) would be first-listed.
of services” or a supplier of services in the Medicare program. Physician Medicare Learning Network Matters SE0746, “Coding for Polypectomy
Assistants may not otherwise organize or incorporate and bill for their services Performed During Screening Colonoscopy or Flexible Sigmoidoscopy,”
directly to the Medicare program, including as, but not limited to sole propri- provides clarification on this issue, bringing CMS instruction in line
etorships or general partnerships. with those in the official guidelines.
“The point is that PAs cannot set up their own corporation and bill Resource tip: You may find MLN Matters SE0746 on the CMS Web site: www.cms.hhs.
gov/MLNMattersArticles/downloads/se0746.pdf. Note that these instructions are specific
Medicare directly for their services, whereas NPs can,” clarifies the arti- to claims filed on the CMS-1500 claim form. For more information on hospital outpatient
cle’s author, Julie E. Chicoine, Esq., RN, CPC. “That is, a group of services filed using the UB-04 claim form, see “Differentiate Conflicting Screening and
Diagnostic Colonoscopy Guidance,” December 2009 Coding Edge, pages 46-47.
PAs that incorporates is not a qualified employer under Medicare rules.”
SE0746 specifies, “Whether or not an abnormality is found, if a ser-
A qualified employer, however, may bill Medicare for a PA’s services,
vice to a Medicare beneficiary starts out as a screening examination
delivered within scope of practice, using the PA’s national provider indi-
(colonoscopy or sigmoidoscopy), then the primary diagnosis should be
cator (NPI) number. Typically, reimbursement is 85 percent of the level
indicated on the form CMS-1500 (or its electronic equivalent) using the
paid to a physician. In the hospital setting, this is true for both inpatient
ICD-9 code for the screening examination.” SE0746 further instructs
and outpatient services.
that if the physician finds a neoplasm during a screening exam, you
MLN Matters MM5221, effective April 26, 2007 specifies, “The should “indicate the secondary diagnosis using the ICD-9-CM code for
employer of a PA may bill the carrier directly for the professional services
the abnormal finding (polyp, etc.).”
of the PA furnished to hospital inpatients and outpatients under the PA’s
For Medicare payers, although you should list the screening diagnosis
Medicare billing number or the PA’s NPI, once the NPI is effective.”
first on the claim form, your diagnosis pointer should nevertheless link
In the office setting, the PA may bill directly or—if the appropriate
the appropriate polyp diagnosis to the diagnostic colonoscopy CPT® code.
requirements as described in the Medicare Benefits Policy Manual, chapter CMS requires this coding. In an example of a screening-turned-diagnostic
15, section 60.0-60.4.C have been met—may report his or her services
colonoscopy, SE0746 instructs you to enter a “2” in the diagnosis pointer
incident-to the physician, under the physician’s NPI number. In the latter
(Item 24E on the CMS-1500 claim form), linking the CPT® procedure
case, reimbursement is 100 percent of the fee schedule amount.
code to the “line 2” diagnosis (that is, the polyp). Further language in
Note that incident-to billing rules do not apply in the hospital. The the article clearly indicates the “2” in Item 24E is “to link the procedure
Medicare Claims Processing Manual, chapter 12, section 30.6.13.E (polypectomy or biopsy) with the abnormal findings (polyp, etc.).”
instructs, “‘Incident to’ E/M visits, provided in a facility setting, are
not payable under the Physician Fee Schedule for Medicare Part B.”
ICD-9-CM Guidelines Are Official for All Payers
In speaking with several CPCs in my area, I’ve learned that many aren’t
aware that they should abide by the ICD-9-CM Official Guidelines for all
6 AAPC Coding Edge
letter from member leadership
We Need Your Help
Most of you may remember when the AAPC sets of notes for every specialty. To help keep
introduced “Code It Forward” a few years this valuable program growing, we need
ago. The intent of the program was for the your reports.
AAPC to receive copies of real redacted phy- We need notes from all specialties, espe-
sician office notes from each specialty with cially pediatrics, dermatology, rheumatology,
which students could practice coding. We and internal medicine. If each of you sends
asked for you to send five notes from each of just five notes, we can make this program
your office specialties with any identifying an even bigger success for our students and
patient information blacked out or removed. membership.
We made the notes available for purchase in
Notes must be Health Insurance Portability
groups of five notes at a time on the AAPC
and Accountability Act (HIPAA) compliant.
Web site.
Please remove all names, demographic infor-
The initial program has been very success- mation, and any other identifying informa-
ful. Thanks to all who contributed specialty tion from the notes. Notes do not have to be
physician notes for the Code It Forward coded prior to sending; they can be coded
program. by the AAPC staff. If you would like to
Because each doctor dictates and documents provide the coding, however, it would be
differently, being able to read and code dif- greatly appreciated.
ferent styles of real world documentation is Send your notes to Kris Taylor’s attention at
invaluable to students taking exams—not the AAPC office by mail (American Acad-
to mention coders on their first job. Gain- emy of Professional Coders, 2480 South
ing real coding experience is difficult, and 3850 West, Suite B, Salt Lake City, Utah
having the ability to code from didactic 84120) or fax [phone]). If you have
notes gives students that first taste of real electronic medical records (EMRs) or office
world coding. transcription, you can e-mail the notes to
Due to the success of the initial program [email protected] as a Microsoft Word
and your comments, we have started a new document. Notes will be retyped by the
program, “Code Around,” which has taken AAPC if they are sent as a different format
on a new life of its own. The intent of Code (eg, PDF).
Around is to provide: I would like to personally thank each of you
 Low cost education for students; who sent notes in the past—we couldn’t have
 Great training material for instructors; made this program happen without you. And
and thank you for your continued support.
 Continuing Education Units (CEUs) Sincerely,
obtained from real coding scenarios.
For members with a specialty credential, it
isn’t always easy to find CEUs. Currently, Terrance C. Leone,
Code Around has at least one set of notes for CPC, CPC-P, CPC-I, CIRCC
every specialty. We hope to have multiple President, National Advisory Board
www.aapc.com January 2010 7
cover
START YOUR OWN BUSINESS
This experienced entrepreneur
steps you through the process.
By Melody S. Irvine, CPC, CEMC, CPC-I, CCS-P, CPMA, CMRS
8 AAPC Coding Edge
cover
Because I trusted my instincts, made some good (and bad)
choices, kept a positive attitude, and learned from all my
experiences; in December 2008 (a little over three years
from the day I opened the doors), my dream came true.
S
everal years ago, I decided to start my own business.  If you really enjoy training and working one-on-
When I put my mind to something, there’s no stop- one with physicians, consider starting a consultant
ping me. How hard could it be? I thought it would be a business. But what type of consulting? Let your
piece of cake. I was wrong. strengths help you decide whether it should be
A few months in, reality hit me—hard. I realized I evaluation and management (E/M), cardiology,
had no clue what I was doing. I had a lot of ideas, but I orthopedics, etc.
wasn’t sure how to turn those ideas into a profitable busi-  If you have a strong background in finances and
ness. I had to slow down, take a deep breath, and educate enjoy the billing side, think about opening your
myself. I read and researched, and networked with other own billing company.
business owners. It took over a year before I finally devel- Be honest about your limitations, and don’t overlook
oped a good business plan. areas where you may need extra help. Often necessi-
Aug. 1, 2005 I quit my job. I spent the next month ties that aren’t considered are bookkeeping, advertising,
preparing to open the doors to my new business, and on organization, etc. To get an idea of what’s involved take
Sept. 1, 2005, I started Career Coders, LLC—a medical a look at the Example Business Check List later in this
billing and coding school in Colorado. I had a desk, a few article.
tables for students, a single computer, and my own teach-
Step 2: Consider the Market and the Competition
ing curriculum. It was a shoestring operation, but I was
proud it was mine. My long term goal was to work from A simple look in the phone book or online Yellow Pages
home in five years; and because I trusted my instincts, will tell you if the market in your area is already flooded
made some good (and bad) choices, kept a positive atti- with the type of service you’re considering offering. What
tude, and learned from all my experiences, I did better do those companies have to offer that you can or can’t
than that. In December 2008 (a little over three years compete with? Be unique. If you offer the same products
from the day I opened the doors), my dream came true. as everyone else, it will be difficult to entice clients.
I now work out of my home with an online school and Once you decide on a specific service, but before you
consulting business. commit to it, test the market. For example, begin by
Having made the sometimes bumpy journey successfully, teaching a small class out of your home or a rented office
I have some advice for anyone contemplating starting a space, or take on a small physician practice and help with
business. their billing and/or claim denials.
Step 1: What Services Do you Want to Offer? Step 3: Have a Plan
Maybe the better questions to ask are: What are you A business plan is crucial. Make sure you have a plan for
really good at; and what are your weak areas? Whatever one month, three months, six months, and one year, as
your answers, choose a business you are passionate about. well as long term goals and plans. To get started, con-
sider these business necessities in your plan:
For example:
 Rent or buy—Utilities, parking, location, immediate
 If you are good at teaching, maybe you should open
improvements. Location is more important than looks
a school. Opportunities include teaching medical
billing and coding, Professional Medical Coding  Capital—Nest egg, bank loan, grant, or credit
Curriculum (PMCC) classes (AAPC offers excellent used to start your business
educational tools), medical terminology, anatomy,  Insurance—Workers’ compensation, health, com-
computer classes, medical software, etc. mercial, liability, and bonds
www.aapc.com January 2010 9
cover
To discuss this
article or topic,
go to www.aapc.com
 Advertising—Corporate identity (logo), business  Are you treating your staff with respect and paying
signage, brochures, Web site (the most expensive top dollar to keep good employees?
part of opening a business). Prepare to knock down  Are you involved? For instance, become more active
doors to get your name out there. with the AAPC and your local chapters, present at
 Equipment—Telephones, computers, faxes, copiers, seminars, join the Better Business Bureau and local
desks, file cabinets, office supplies, furniture, Chamber of Commerce, attend job fairs and medi-
Internet, etc. cal community events.
 License—State, federal, and educational  Are you constantly improving your services? Start
 Development—Policies, procedures, curriculum small and then build and refine your services.
(paper or Web-based), pricing Step 5: Make Customer Service a Priority
 Accounting system—Payroll, software, CPA, Customer service can make or break a business—there
credit cards, bank accounts
is no room for error. You MUST get it right. Good cus-
 Legalities—Trade name, copyright, contracts, tomer service practices include:
partnerships
 Getting back to people quickly. Don’t make them
 Financial low padding—All business have their wait.
down months. Make sure you have a financial
 Being professional, ethical, dependable, and trust-
cushion for those low months.
worthy.
Remember: There are always exceptions to the rules.  Giving some of your services away, just so people
If your business plan includes the prospect of a partner- get to know what you do.
ship, first consider the pros and cons:
 Listening well. Hear what people want. If you are
Pros: good at what you do, word of mouth is your best
 Two heads are better than one advertisement.
 Having more capital  Caring about others.
 Sharing late hours and work load, etc.
Step 6: Be Persistent
Cons:
Attitude is important. All of us have gone through dif-
 Personalities may clash
ficult times in our lives. I have had my fair share of
 Business ethics may differ disappointments and roadblocks. I believe the power of
 Work habits may conflict positive thinking is the key to success.
Know that you and your family may have to make some
Step 4: Build a Good Business Foundation
sacrifices. Running your own business requires work-
When and if the time comes to hire help, make sure your
ing away from home, late hours, and weekends. Without
business staff has the experience and quality to back up
family support, it is difficult to run a successful business.
your product. Consider these questions:
I am very fortunate to have a supportive family. I never
 Do you have the experience, work ethic, credentials, forget that my family comes first.
and reputation in the field to attract good employees?
If you have the courage to go out of your comfort zone,
Is your product/service top of the line at all times?
stick to it, and fight for it, you may have what it takes to
 Are your staff members credentialed, professional, start a business. You can have anything you want in life
ethical and moral, and reliable? Staff members if you are willing to work hard, have a true passion for
should go above and beyond your expectations. Are what you do and, most of all, believe in yourself.
you hiring minors? You may want to perform back-
ground checks on employees.
 Did you hire individuals with areas of expertise? Melody S. Irvine,
CPC, CEMC,
Highly-qualified individuals will make your ser- CPC-I, CCS-P,
CPMA, CMRS,
vices valuable and credible. is an AAPC NAB
member.
 Do you provide excellent training to your staff?
10 AAPC Coding Edge