Check Bundling Rules ATT/R

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February 2012
Check ATT/R
Bundling Rules
Ken Camilleis, CPC, CPC-I, CMRS
Plus: Pacemakers/Defibs • Hospital Work Plan • Compliance • Ergonomics • 95165 • Stress
Expert guidance to each
CPT®2012 change
An indispensable guide for CPT® codebook users.
Written by the CPT coding staff, this book provides the official
AMA interpretations and explanations for each CPT code and
guideline change in the CPT 2012 codebook. Every new,
Instantly search each
edition of the AMA’s
best-selling CPT®
New! Changes: An Insider’s
View. To learn more
and order today visit
the all-new site at
amacodingonline.com
revised, and deleted code, text, and guideline change is listed
along with a detailed rationale for the change.
Rationale
A parenthetical note has been placed following code 97032 to direct users to the
appropriate code to use to identify transcutaneous electrical modulation pain
reprocessing (TEMPR/scrambler therapy). For more information regarding reporting for this type of service, see the rationale following code 0278T.
“At-a-glance” tabular review
of 2012 changes allows you to
easily determine the level to
which your particular field has
been affected by the changes.
Therapeutic Procedures
97140
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual
traction), 1 or more regions, each 15 minutes
(Do not report 97140 in conjunction with 29581-29584)
Rationale
In support of the addition of new multi-layer compression procedures, an exclusionary parenthetical note has been added following 97140 precluding the
reporting of manual therapeutic techniques code 97140 in conjunction with the
application of multilayer compression procedures 29581, 29582, 29583, or 29584.
Useful clinical examples
and procedural descriptions
are presented to help you
understand the practical
application for that code.
Special Services, Procedures and Reports
The procedures with code numbers . . .
Code 99091 should be reported no . . .
If the services described by 99091 . . .
Do not report 99091 if it occurs within . . .
Codes 99050-99060 are reported in addition to an associated basic service. Do not append modifier
51 to 99050-99060. Typically only a single adjunct code from among 99050-99060 would be reported
per patient encounter. However, there may be circumstances in which reporting multiple adjunct codes
per patient encounter may be appropriate.
Rationale
The Special Services, Procedures and Reports introductory guidelines have been
revised to note that modifier 51 should not be appended to the adjunct to basic
services codes 99050-99060.
Organized by CPT code
section and code number,
just like the CPT codebook.
MISCELLANEOUS SERVICES
99000
99090
Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory
Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data);
(For physician/qualified health care professional collection and interpretation of physiologic data
stored/transmitted by patient/caregiver, see 99091)
Detailed rationales provide
an explanation as to why the
code change occurred.
258
Medicine
=Modifier 51 Exempt
~=Moderate Sedation ✚ =Add-on Code
537
CPT® changes
in 2012!
New: 278
Revised: 139
Deleted: 98
Resequenced: 22
a=FDA approval pending
This annual edition of the CPT code changes is an
essential reference for the CPT coder and biller.
- LouAnn Schraffenberger, MBA, RHIA, CCS, CCS-P
Order Today! Call (800) 621-8335 or
order online at amabookstore.com.
Contents
16
24
42
[contents]
February 2012
In Every Issue
7 Letter from the Chairman and CEO
9 Letter from Member Leadership
10 Letters to the Editor
11 Coding News
28
Features
16 Rethink Pacemaker and Defibrillator Coding in 2012
David B. Dunn, MD, FACS, CIRCC, CPC-H, CCC
20 Overcome Coders’ Top 10 Compliance Concerns: Part 1
Marcella Bucknam, CPC, CPC-H, CPC-P, CPC-I, CCC, COBGC, CCS-P, CCS
28 Optimize Adjacent Tissue Transfer/Rearrangement Reimbursement
Ken Camilleis, CPC, CPC-I, CMRS
32 2012 Brings All-inclusive Codes for Interventional Radiology
David Zielske, MD, CPC-H, CIRCC, CCC, CCS, RCC
36 Hospitals: Set a Course for Compliance
Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P
38 Coders: Protect Your Most Valuable Asset—You!
Steve Gray, AOES, COSS
40 Revisit the Rules with a Revised ABN
G. John Verhovshek, MA, CPC
42 Relieve Coding Stress: Help Your Ticker
Michelle A. Dick
44 Teach Medical Terminology, the Fun Way
Geanetta Johnson Agbona, CPC, CPC-I, CBCS
Ken Camilleis, CPC, CPC-I, CMRS, of Cape Cod, Mass., knows that before
he ventures out to code adjacent tissue transfer/rearrangement (ATT/R), he must check
bundling rules. Cover photo by Steve Baty (www.allmediapro.com).
On the Cover:
Special Features
OnlineTest Yourself – Earn 1 CEU
Go to: www.aapc.com/resources/
publications/coding-edge/archive.aspx
14 Quick Tip: Compliance
15 Quick Tip: Subsequent Care Codes
23 Hot Topic: CPT® 95165
24 ICD-10 Roadmap: Myocardial Infarction
50 Minute with a Member
Education
12 AAPCCA: Remote Meetings
13 AAPCCA Handbook Corner
45 Newly Credentialed Members
Coming Up
• 2012 Arthroscopy
• Save Your Eyes
• 2012 Spinal Decompression
• Same-day Procedures
• CMS Three-day Rule
www.aapc.com
February 2012
3
Serving 111,000 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:
Chairman and CEO
Reed E. Pew
[email protected]
Vice President of Finance and Strategic Planning
Beginning coding with common technologies, basic
anatomy and physiology, and using standard code
guidelines and regulations.
APPRENTICE
PROFESSIONAL
EXPERT
February 2012
Korb Matosich
[email protected]
Vice President of Marketing
More sophisticated issues including code
sequencing, modifier use, and new technologies.
Bevan Erickson
[email protected]
Vice President of ICD-10 Education and Training
Advanced anatomy and physiology, procedures and
disorders for which codes or official rules do not exist,
appeals, and payer specific variables.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC
[email protected]
advertising index
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]
Director of Member Services
Danielle Montgomery
[email protected]
CodingWebU..................................................31
www.CodingWebU.com
Director of Publishing
Brad Ericson, MPC, CPC, COSC
[email protected]
Contexo Media...............................................51
www.contexomedia.com
Managing Editor
John Verhovshek, MA, CPC
[email protected]
HealthcareBusinessOffice, LLC.....................22
www.HealthcareBusinessOffice.com
Ingenix is now OptumTM.................................17
www.optumcoding.com
Medicare Learning Network® (MLN).............35
Official CMS Information for
Medicare Fee-For-Service Providers
http://www.cms.gov/MLNGenInfo
NAMAS/DoctorsManagement.................. 6, 52
www.NAMAS-auditing.com
American Medical Association........................2
www.amabookstore.com
ZHealth Publishing, LLC..................................5
www.zhealthpublishing.com
Executive Editors
Michelle A. Dick, BS
[email protected]
Tina M. Smith, AAS
[email protected]
Renee Dustman, BS
[email protected]
Production Artists
Renee Dustman, BS
[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)
©2012 AAPC, Coding Edge. All rights reserved. Reproduction in whole or in part, in any form,
without written permission from AAPC is prohibited. Contributions are welcome. Coding Edge
is a publication for members of 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 2011 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®, CPCOTM, CPMA® and CIRCC® are registered trademarks of AAPC.
Volume 23 Number 2
February 1, 2012
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
2012 CPMA® Class Schedule
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The NAMAS 2-day Certified Professional Medical Auditor (CPMA®) training delivers expert
training to coders. Coders will learn:
Tuition
How to communicate results and educate providers
NAMAS CPMA® Training
Valuable skills in auditing abstraction
$1025 (Regular Cost)
Scope and statistical methodologies
$895 (AAPC & AHIMA Members)
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We will come to you! To request a class in your area call us at
877-418-5564 or email [email protected]
2012 Class Date
Class Location
2012 Class Date
Class Location
1/10 - 1/11
Knoxville, TN
4/12 - 4/13
Dallas, TX
1/25 - 1/26
New Orleans, LA
4/18 - 4/19
Minneapolis, MN
2/8 - 2/9
Houston, TX
4/24 - 4/25
Charlotte, NC
2/22 - 2/23
Birmingham, AL
5/2 - 5/3
Philadelphia, PA
3/7 - 3/8
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5/10 - 5/11
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Letter from the Chairman and CEO
Change Inevitable in 2012
I
wish I could give you the results of the
Certified Professional Coder-Apprentice
(CPC-A®) elimination proposal, but at
the time this was written for publication, it
was far too soon to produce conclusive results. We will let everyone know the results
during February.
Where Is Health Care Headed?
I confess, I continue to be concerned with
the cost of health care in the United States.
The baby boom generation is knocking on
the door of retirement, which will swell
Medicare rolls and overwhelm physician
offices. We are training no more physicians
now than we did 20 years ago, and in fact,
some medical schools are reducing enrollment. Cost increases have not slowed down.
Audits are increasing. There will be an election in 10 months that will determine the
future of health reform.
Insurance Comes Between Patient and Provider
I still believe our high costs are caused due
to a disconnection between the patient and
the provider. If a decision has to be made
as to whether to do something, often it is
answered by if the patient’s insurance will
pay for it. Most physicians give their clients good information, but often it’s about
the risks associated with not performing a
procedure. For example, “If it’s not done,
there is a __ percent risk you’ll need more
complicated surgery,” or “you’ll develop
________ (something negative).” Sometimes, the risk is low and the procedure is
not performed. But, when insurance is paying, risk is often ignored and most procedures are done.
When Only the Patient and Physician Decide
I learned about this recently when I chose to
have Lasik eye surgery. This was a do-over
from surgery that was performed about four
years ago, and my insurance did not pay it.
I had to carefully consider the cost against
how well I was able to see. I also had to determine if I wanted to pay a couple hundred
dollars more to get what the ophthalmologist said was a 10 percent better chance of a
better result. I’m usually a pretty quick decision-maker (AAPC employees may argue
I’m a lightning-fast decision-maker.), but I
took my time deciding whether to have the
procedure. The process gave me insight into
how medical decisions change when insurance is not involved: It was just the physician
and me, my sight, and my wallet. I definitely
weighed the cost vis-à-vis the potential end
result and whether I thought it was worth
it. I could have also just purchased glasses.
I also now understand how those without
health insurance view every medical decision. And, being unemployed, on a fixed income, etc., makes those decisions even harder because funds are meager.
Three Steps to Affordable Health Care
I genuinely believe the only ways to reduce
overall medical costs are for all Americans
to do the following:
Live a healthy lifestyle. We need a better
diet and more exercise. Cease smoking, illicit drugs, etc. Eat more veggies, fish, and
a lot less sugar.
Get insurance policies with higher deductibles and lower costs. This will require us to make better informed decisions
about health care decisions. Medicare may
have to go this way, unless they are willing
to live with screaming doctors after the Sustainable Growth Rate (SGR) cuts are finally
implemented. So far, they have not.
Manage our own health care. My 68-yearold primary care physician told me that
studies show managing our own care gives
us better health than when we leave it to the
physician. He told me to get a cheap blood
pressure monitor and monitor it myself. I
did. We know our bodies best and can determine when we need to see a doctor or
when we need to rest, exercise, drown ourselves in vitamin C, or eat chicken noodle soup.
Everyone in health care will be better off if
America gets healthier.
Your friend,
Reed E. Pew
Chairman and CEO
www.aapc.com
February 2012
7
2012 ICD-10
IMPLEMENTATION BOOT CAMPS
If you haven’t started preparing for ICD-10 implementation our two-day
Boot Camp can get you on track. These are the last implementation
training sessions before we transition to code set training in September
and space will be severely limited. Our curriculum includes:
• Provider impact assessments
• Software and systems updates
• Budgeting and training considerations
• ICD-10 mapping
• Differences between ICD-9-CM and ICD-10-CM
• Importance of clinical documentation
• Performing documentation readiness assessments
REGISTER TODAY!
aapc.com/2012bootcamps
800-626-CODE (2633)
FEBRUARY & MARCH IMPLEMENTATION BOOT CAMPS
DATE
LOCATION
PRESENTER
Feb 2
Cleveland, Ohio
Jacqueline J Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC
Feb 2
Andover, Kansas
Brenda Edwards, CPC, CPMA, CPC-I, CEMC
Feb 2
Anaheim, California
Corrie L Alvarez, CPC, CPC-I, CEDC
Feb 9
Honolulu, Hawaii
Essie White, CPC, CPC-H, CPMA, CPC-I, CGSC
Feb 9
Oklahoma City, Oklahoma
Peggy A Stilley, CPC, CPMA, CPC-I, COBGC
Feb 9
Palm Springs, California
Corrie L Alvarez, CPC, CPC-I, CEDC
Feb 9
Daytona Beach, Florida
Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC
Feb 16
Jacksonville, Florida
Kathleen Michele Rowland, CPC, CPC-I, CEMC
Feb 16
Little Rock, Arkansas
Peggy A Stilley, CPC, CPMA, CPC-I, COBGC
Feb 23
Nashville, Tennessee
Kathleen Michele Rowland, CPC, CPC-I, CEMC
Feb 23
San Bernadino, California
Linda D Hallstrom, CPC, CPMA, CPC-I, CEMC
Mar 1
Harrisburg, Pennsylvania
Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
Mar 1
Philadelphia, Pennsylvania
Jacqueline J Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC
Mar 1
Fort Wayne, Indiana
Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I
Mar 8
Manhattan, New York
Yvonne D Dailey, CPC, CPC-I
Mar 8
Louisville, Kentucky
Jacqueline J Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC
Mar 8
Savannah, Georgia
Peggy A Stilley, CPC, CPMA, CPC-I, COBGC
Mar 15
Kansas City, Missouri
Brenda Edwards, CPC, CPMA, CPC-I, CEMC
Mar 15
Tampa Bay, Florida
Betty Johnson, CPC, CPC-H, CPMA, CPC-I, CPCD
Mar 15
San Jose, California
Corrie L Alvarez, CPC, CPC-I, CEDC
Mar 30
Las Vegas, Nevada-
Kimberly Reid, CPC, CPMA, CPC-I, CEMC
For a complete list of all remaining boot camps visit
aapc.com/2012bootcamps
Letter from Member Leadership
Understand and Simplify
the Cardiovascular System
A s St. Valentine’s Day approaches, the heart frequently has been on my mind. Although many
appropriately think of the sentimental kind of
heart (e.g. love), I wanted to bring attention to
this amazing organ, as well. So, to stay in tune
with the upcoming holiday and the American
Heart Association’s designation of February as
“American Heart Month,” let’s discuss what the
heart means for medical professionals.
We all see and hear of the results of heart disease
every day. Heart disease kills 600,000 men and
women annually. It is the No. 1 killer of women in America, more than all forms of cancer
combined.
A Pioneer Makes Strides in Heart Disease Prevention
Heart disease diagnosis, intervention, and treatment have advanced tremendously in the past 50
years. One of the major turning points occurred
in 1930 when a German surgical intern, Werner
Forssmann, theorized the basics of cardiac catheterization. His superiors dismissed his idea, so
Forssmann tested his theory by inserting a urological catheter into the antecubital vein in his
elbow. He used fluoroscopic control and a mirror to manipulate it to his right atrium. He then
walked two flights of stairs to have his chest Xrayed, showing the catheter in his right auricle,
making him the first to document right heart
catheterization in humans using radiographic techniques.
Although he faced disciplinary actions for selfexperimentation and the hospital fired him for
his efforts, many years later, in 1956, he was
awarded the Nobel Prize for his achievement,
which is now the standard method of cardiovascular hemodynamic study.
Demystify A&P of the Heart
We now face the coming changes ICD-10-CM
will bring to our field and the subsequent need
to increase our knowledge of anatomy so we may
employ this new diagnostic coding system. Over
the past two years numerous coders have told me
that anatomy and pathophysiology (A&P) of the
heart is difficult to comprehend.
Although I have never worked in the specialty of
cardiology, I was asked several years ago to speak
on this subject. To prepare, I learned everything
I could before presenting. I developed tricks to
remember the components and functions of the
heart and to teach this information to others.
Take a Journey to Heart Town
I used the analogy that the heart is a city; we’ll
call it “Heart Town.” The electrical system is the
signal lights (sinoatrial (SA) and atrialventricular (AV) nodes), and the communication system
and toll gates between these signals (bundle of
His, bundle branches, and Purkinje fibers) control their actions. Next, consider the vessels of
the cardiovascular system the roadway traveled
from (arterial system) and to (via veins) Heart
Town. Consider the major vessels, the aorta and
the superior and inferior vena cavas, as the interstate, the lesser veins and arteries are the state
highways, and the arterioles and venules are the
country roads, all leading to and from the very
small villages of “Capillaryville.” Let’s take a
journey to Heart Town to drop off carbon dioxide and pick up oxygen:
Begin in Capillaryville, in the south, and head
north on Venule Road to Vein Highway, and
then on to inferior vena cava, the interstate.
Head north on vena cava towards Heart Town.
Enter Heart Town on the northwest side (upper right) and you will be in the right atrium.
Wait for the SA node signal to change, and then
pass through the tricuspid gate into the right
ventricle.
The SA signal is the most important as it sends
the signal on to the atriums to contract and open
the gates (tricuspid and mitral valve) on both
north sides of Heart Town. The AV signal relays this message to the bundle of His, bundle
branches, and Purkinje fibers, which control the
remaining gates (pulmonary and aorta) by causing the ventricles on the south side to contract.
At the next signal (AV node), pass through the
pulmonary value and onto pulmonary artery,
which will take you to the lungs’ Capillaryville,
where you can pick up oxygen.
Return to Heart Town via the pulmonary vein
to the left atrium on the east side of the city. Go
through the mitral valve gate to the left ventricle.
Once open, travel through the next gate (aortic
valve) and onto the Aorta Interstate.
Don’t take the first exit on the Aorta Interstate or
you’ll wind up on the outer loop of Heart Town,
also known as Coronary Artery Road, where
you’ll have to go back through Heart Town before you make it back to the Capillaryville in the
south. Continue heading south on Aorta Interstate to Artery Highway, and then to Arteriole
Road and home to Capillaryville.
This is a simplified method of understanding
the cardiovascular system. I hope it will interest you enough to create your own road map to
Heart Town.
For more heart-related information, be sure to
read this month’s Coding Edge.
Happy Valentine’s Day, my friends,
Cynthia Stewart, CPC, CPC-H, CPMA,
CPC-I, CCS-P
President, National Advisory Board
www.aapc.com
February 2012
9
Letters to the Editor
Please send your letters to the editor to:
[email protected]
Burn Code Category 948 Requires a Fifth Digit
NEWS
Many members contacted us about the Coding Edge article “Account for Percentage and Depth when Coding Burns” (December 2011, pages 20-23), which erroneously stated that ICD-9-CM
code category 948 Burns classified to extent of body surface involved
“requires a fifth digit if the burn is third degree; otherwise, use
the appropriate four-digit code based on the percentage of burned
body surface.”
In fact, a fifth digit is always required when reporting category
948, regardless of the percentage of body area affected by third degree burns. For example, for a second degree burn affecting only
the tip of the right ear, proper reporting of category 948 would
be 948.00 Burn (any degree) involving less than 10 percent of body
surface with third degree burn of less than 10 percent or unspecified
amount. The forth digit indicates the percentage of body area affected by burns of any degree (less than 10 percent) and the fifth
digit indicates the percentage of body area affected by third degree burns (also less than 10 percent).
Or, for example, if 30 percent of the body were burned, including
10 percent with third degree burns, the correct reporting of category 948 would be 948.31 Burn (any degree) involving 30-39 percent of body surface with third degree burn of 10-19%.
Always report a 948.xx code with burn location/degree codes
940-947 to provide greater specificity and indicate medical necessity for any medical services and procedures billed.
Coding Edge
Stay Current on CEUs
AAPC certified members are required to earn
Unfortunately, delinquent submissions of
make sure to stay current on your CEUs and
continuing education units (CEUs) within their
CEUs are trending up at a rapid pace. To
submit them on time.
specified renewal period to ensure they stay
counteract this trend, AAPC will implement
For more information on how to obtain your
current on critical industry information and
a $50 CEU extension fee effective April 30,
CEUs and the rules for extensions, go to www.
to maintain the integrity of their credential(s).
2012. To avoid this extension fee, please
aapc.com/medical-coding-education/index.aspx.
FEBRUARY & MARCH
WEBINARS
DATE
TOPIC
Feb 1
Orthopedics Case Studies: Upper and Lower Extremities
Feb 8
Ensuring Accuracy: Chargemaster and Outpatient Facility Coding
Feb 15
Defending an Adverse E/M Audit: What the E/M Guidelines Really Say
Feb 29
Cardiovascular and Electrophysiology
Mar 7
“Fat Albert’s Hernia”
Mar 14
Health Maintenance Exams: What’s Covered and What is Significant to
E/M Code?
Mar 21
Responding to PostPayment Audits: Taking Control of the Audit
Process and Result
Mar 28
Incident-to Billing As It Relates to NPPs
$99 Each or $795 Annual Subscription
(Includes 40+ 2012 Events)
Visit aapc.com/2012webinars and buy your 2012 Webinar Subscription today!
Call 800-626-CODE (2633)
10
AAPC Coding Edge
Coding News
CMS Restores Bilateral
Chemodenervation Coding
For 5010 Compliance,
Non-specific Codes Require More
In April 2011, Medicare changed the bilateral surgery indicator for
chemodenervation codes 64613 Chemodenervation of muscle(s); neck
muscle(s) (eg, for spasmodic torticollis, spasmodic dysphonia) and 64614
Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg,
for dystonia, cerebral palsy, multiple sclerosis) to “2,” meaning “150%
payment adjustment does not apply. RVUs [relative value units] are
already based on the procedure being performed as a bilateral procedure.” Prior to that date, 64613 and 64614 were assigned a “1” bilateral surgery indicator, which meant that a 150 percent payment
adjustment applied when either procedure was performed bilaterally (for more information, see “Bilateral Chemodenervation Coding
Non-covered,” June 2011 Coding Edge, page 8).
Per the most recent Medicare Physician Fee Schedule (MPFS) Relative
Value file (www.cms.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage),
the Centers for Medicare & Medicaid Services (CMS) has changed
the bilateral surgery indicator for 64613 and 64614 back to “1,” effective Jan. 1, 2012. For example, if the provider injects botulinum
toxin into bilateral anatomic sites, such as the right and left upper extremities, you would report the appropriate code with modifier 50
Bilateral procedure appended (e.g., 64614-50). Payment for the procedure should be 150 percent of the usual amount.
The new electronic transaction standard, implemented Jan. 1, requires providers and suppliers acting under the Health Insurance
Portability and Accountability Act (HIPAA) to also include a corresponding description of a service or supply reported with a nonspecific code.
Although HIPAA enforcement of 5010 compliance is deferred until March 31, providers should ensure this implementation guide requirement is followed when submitting a HIPAA-compliant claim
for all non-specific procedure codes.
Non-specific procedure codes are those that include in their descriptors: Not Otherwise Classified (NOS), Unlisted, Unspecified, Unclassified, Other, Miscellaneous, Prescription Drug Generic, or Prescription Drug Brand Name.
There is no crosswalk of non-specified procedure codes with corresponding descriptions; and a non-specific procedure code’s descriptor term does not fulfill the requirement. Claims for non-specific
codes without proper descriptions will be rejected.
Source: MLN Matters® SE1138
(www.cms.gov/MLNMattersArticles/downloads/SE1138.pdf)
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February 2012
11
AAPCCA
By Barbara Fontaine, CPC
Remote Meetings Can’t Replace Live Meetings
There’s more to local chapter meetings than continuing education units (CEUs).
M
embers of the AAPC Chapter Association (AAPCCA) Board of Directors
took a long look at whether AAPC should allow chapters to host remote
meetings for their members. AAPC tries to accommodate as many members
as possible, but this would be a big change in the way the Local Chapter Handbook is
written. All sides of the question were considered and a task force was formed to investigate the possibilities and different perspectives.
Getting to Meetings Is a Challenge for Some
AAPCCA’s task force wanted to hear from coders in places where remote meetings
could be helpful. Some of us came into the group thinking we really needed to allow
this change because we represent AAPC members from some pretty remote places,
where geography and weather make it nearly impossible to hold a meeting.
iStockphoto©Michelle Gibson
Value of Networking Is Priceless
As we talked to members in remote places, and amongst ourselves, perspectives changed. It soon became clear
that CEUs are NOT the only reason to attend meetings. Some members have employers who pay for AAPC webinars and they do not need meetings for CEUs; however, they go anyway. They realize the value of networking. The ability to ask questions of experts in the room is invaluable; and in this economy especially, meeting
someone with a job tip or an interview is priceless.
Solutions for Hard-to-reach Meetings
If you live in one of those places where it’s tough to get to a meeting, we have some suggestions from chapters
who have a workaround for their hard-to-reach meetings:
• Vermont holds longer meetings in the warmer months because they can’t meet in winter.
• Hawaiians must take time off from work and fly to another island to attend meetings, so they rotate
where the meeting is. That way each group only has to fly every other month.
• South Dakota hosts annual conferences, alternating from one side of the state to the other.
These are extreme solutions for extreme cases—and yet, chapter members still attend meetings.
Encourage Chapter Growth and Professionalism
We heard from chapter officers who expend a great deal of time and effort planning meaningful, informative
meetings with great speakers. These officers said they feel people who attend meetings might not if remote
meetings become readily available; and in the long run, that would
jeopardize their chapter.
Although staying home in your pajamas and listening to a meeting might sound like a wonderful, cozy idea, it defeats the mission of AAPCCA, which is to promote chapters. AAPC’s mission
is to encourage professionalism, networking, “Upholding a Higher Standard,” and supporting members as they put their best foot
forward—hopefully, in a nice polished, professional shoe, and not
a comfy, old slipper. It’s worth it!
“Hawaiians must take time off from
work and fly to another island to
attend meetings, so they rotate
where the meeting is.”
Barbara Fontaine, CPC, serves on the AAPC Chapter Association (AAPCCA)
Board of Directors and is business office supervisor at Mid County Orthopaedic
Surgery and Sports Medicine, a part of Signature Health Services. She served
on several committees before becoming a local chapter officer. In 2008, she
earned the St. Louis West, Mo. local chapter and AAPC’s Coder of the Year
awards.
12
AAPC Coding Edge
AAPCCA Handbook Corner
By Brenda Edwards, CPC, CPMA, CPC-I, CEMC
Conduct Yourself Properly
at Chapter Meetings
Chapter meetings are a wonderful place for networking, education, and attitudes ... what? Attitudes? Sometimes in the quest to
be the best, passion is misconceived. The intent may be good,
but heated actions and words may be perceived in a bad light if
not communicated effectively.
The Local Chapter Handbook addresses meeting conduct in
chapter 7, section 3:
3. Conduct at Chapter Meetings
3.1 Chapter meetings shall be conducted in an orderly and professional manner. Local chapter officers are responsible to ensure
order is maintained during all chapter activities and are, therefore,
empowered to ask attendees to leave a chapter meeting.
3.11 Members and officers alike are to be aware that when attending meetings or conducting chapter business, their words and
actions may be seen as a reflection on the organization, each of
the local chapters, and the individual members. With this in mind,
it is expected that members and officers will conduct themselves
accordingly.
To foster effective, positive
communications, every local
chapter member has the right
to participate in local chapter
meetings. Consider yourself
a goodwill ambassador and
greet members at every
meeting. Introduce yourself
and get to know members’
names and faces. Although you may
feel shy, if you don’t speak up, you could be perceived
as unapproachable. If you reach out to somebody you have not
addressed at past meetings, members will be more inclined to
become involved.
Every chapter member has the right to express his or her opinion
at chapter meetings. Some decisions involve the entire membership and chapter members should be given the opportunity to
give feedback. Respect is important: Remember that your opinion
is probably not the only opinion.
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February 2012
13
Apprentice
Quick Tips
By Mary Pat Whaley, FACMPE
In the context of health care, compliance is all about what we don’t do, rather than what
we do. Here are 16 common sense and simply worded rules to keep your practice out of
harm’s way.
Common
Sense Billing
and Coding
Compliance
1. If it wasn’t documented, it wasn’t
done.
11. Don’t discount care to patients for
referring other patients.
2. If it wasn’t done, it can’t be billed.
12.Unless financial need is documented,
patient balances are not waived.
3. If the service isn’t necessary, it won’t
be provided.
4. If you weren’t there, your name won’t
appear in the medical record or on
the claim.
5. Don’t double bill the payer.
6. Don’t change the place of service to
maximize payment.
7. Don’t unbundle services that are part
of a single service.
8. Don’t charge for related services
during the global period.
9. Don’t upcode or downcode services.
10. Don’t neglect modifiers that would
change the payment.
13. If the patient or payer overpays, don’t
keep the money.
14. If the payer denies payment based
on the diagnosis, don’t change the
diagnosis to achieve payment.
15. If your physician is offered money
or gifts to prescribe drugs, refer
patients, or order procedures/tests,
decline.
16. If a test or procedure is needed, don’t
direct patients to a facility you partially own without disclosing the
practice’s invested interest.
Pain Pump Placement Probably Won’t Pay
A Coding Edge reader asked, “What is the appropriate
coding for placement of an ON-Q pain pump?”
The cited portion of the IOM deals with the global surgical package, and
requires that “postoperative pain management by the surgeon” be included in the global surgical fee.
I-Flow, the manufacturer of the ON-Q C-bloc Continuous Nerve Block
System, recommends several CPT® codes to report placement, depending
on location, including:
Regence BlueShield similarly refuses separate payment in its Reimbursement Policy, stating:
“The CPT® or HCPCS Level II code(s) used to describe a surgical procedure includes all services integral to accomplishing the procedure, including but not limited to:
64416
Injection, anesthetic agent; brachial plexus, continuous infusion by
catheter (including catheter placement)
64446
Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement)
1. Topical or regional anesthetic administered by the physician performing the procedure.
64448
Injection, anesthetic agent; femoral nerve, continuous infusion by
catheter (including catheter placement)
2. Application, management, and removal of postoperative dressings
including anesthetic devices.
64449
Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)
Therefore, placement of the pain pump catheter(s) for postoperative pain
control is not eligible for separate reimbursement as it is considered included in the allowance for the primary procedure.”
You may also find recommendations to report 11981 Insertion, non-biodegradable drug delivery implant for placement of a pain pump.
In fact, most payers do not agree with any of the above recommendations,
and in almost every instance will bundle placement of the pump into the
primary surgical service.
For instance, Noridian Administrative Services, LLC, Part B Medicare administrative contractor for six states in Jurisdiction 3, as well as three additional states, advises “CPT® 11981 should not be used when billing the
On-Q Pain Pump or similar device.” Noridian further states, “Placement
and management of these pumps by the surgeon is included in the global
component of the surgical procedure code and is not separately payable per
the CMS Internet Only Manual (IOM), Publication 100-04.”
14
AAPC Coding Edge
These two examples are typical of Medicare and private payer policies regarding pain pumps. When medically-necessary and properly documented, some payers may pay for the pump supply using HCPCS Level II codes
A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour
or A4306 Disposable drug delivery system, flow rate of less than 50 ml per hour,
as appropriate.
It may be worth your effort to survey your payers to determine if they will
reimburse for pain pump placement (a review of online chatter suggests that
some insurers may pay these claims). Don’t be surprised if the answer is “no,”
however—and if the insurer does agree to pay, be sure to get its recommendations in writing before you submit a claim.
Professional
Quick Tip
Use Subsequent Care Codes for Low-level Initial Visits
A Coding Edge reader recently asked:
If a physician does not meet the documentation requirements for the lowest level initial hospital visit (99221
Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components; A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity), what code would be used?
The Centers for Medicare & Medicaid Services (CMS) addressed
this issue shortly after announcing that it would no longer accept
CPT® inpatient consultation codes (99251-99255). MLN Matters® SE1010 (www.cms.gov/MLNMattersArticles/downloads/SE1010.pdf) answers key questions on how to report inpatient evaluation and management (E/M) services in lieu of 99251-99255. Among them, the
following Q&A (cited from MLN Matters SE1010) states that subsequent hospital care codes (99231-99233) are appropriate if a service does not support the lowest-level, initial inpatient visit (99221):
Q.
How should providers bill for services that could be described by
CPT® inpatient consultation codes 99251 or 99252, the lowest two of five levels of the inpatient consultation CPT® codes,
when the minimum key component work and/or medical necessity requirements for the initial hospital care codes 99221 through 99223 are
not met?
A.
There is not an exact match of the code descriptors of the low
level inpatient consultation CPT® codes to those of the initial hospital care CPT® codes. For example, one element of inpatient
consultation CPT® codes 99251 and 99252, respectively, requires “a
problem focused history” and “an expanded problem focused history.” In contrast, initial hospital care CPT® code 99221 requires “a detailed or comprehensive history.” Providers should consider the following two points in reporting these services. First, CMS reminds
providers that CPT® code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than
CPT® consultation codes 99251 and 99252, are met by the service
furnished to the patient. Second, CMS notes that subsequent hospital care CPT® codes 99231 and 99232, respectively, require “a problem focused interval history” and “an expanded problem focused interval history” and could potentially meet the component work and
medical necessity requirements to be reported for an E/M service
that could be described by CPT® consultation code 99251 or 99252.
The same MLN Matters article assures providers that Medicare contractors will allow for initial visits reported using subsequent care
codes.
Q.
iStockphoto©Alexander Raths
How will Medicare contractors handle claims for subsequent
hospital care CPT® codes that report the provider’s first E/M service furnished to a patient during the hospital stay?
A.
While CMS expects that the CPT® code reported accurately
reflects the service provided, CMS has instructed Medicare
contractors to not find fault with providers who report a subsequent
hospital care CPT® code in cases where the medical record appropriately demonstrates that the work and medical necessity requirements
are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider’s first
E/M service to the inpatient during the hospital stay.
CMS provided this guidance in the context of reporting services in
lieu of consultations, but most Medicare contractors have adopted
the guidelines more broadly, to apply whenever an initial inpatient
service does not meet the requirements of 99221.
Third-party payers may follow different rules, with some payers
specifying the use of unlisted E/M service code 99499 Unlisted evaluation and management service. Check your contracts or contact the
payer directly for its guidelines.
www.aapc.com
February 2012
15
Professional
Feature
By David B. Dunn, MD, FACS, CIRCC, CPC-H, CCC
Rethink Pacemaker and
Defibrillator Coding in 2012
New usage and definitions
have changed code selection
significantly from 2011.
Once again in 2012, CPT® includes significant changes to codes
for pacemakers and cardioverter-defibrillators, including nine new
codes, 14 code revisions (several of which completely change code
use in comparison to 2011), and new definitions for pacemakers and
defibrillators. A single lead system now denotes pacing and sensing
in one chamber; a dual lead system denotes pacing and sensing in
two chambers; and a multiple lead system denotes pacing and sensing in three or more chambers.
The best way to evaluate the new and revised codes is to group them
according to the procedures performed (new codes are indicated
with a circle; revised codes are indicated with a triangle).
The codes for the insertion of a generator only when the existing
leads are already in place are:
Pacemaker Defibrillator
▲33212
▲33240
Existing single lead
▲33213
●33230
Existing dual leads
●33221
●33231
Existing multiple leads
Notes:
– Use of these codes is expected to be infrequent.
– No generator is removed with these codes.
The codes for the removal of an existing generator and its replacement with a new generator for battery depletion/end-of-life indicators are:
Pacemaker Defibrillator
●33227
●33262
Single lead system
●33228
●33263
Dual lead system
●33229
●33264
Multiple lead system
Notes:
– No leads are inserted or replaced with these codes.
– Removal codes 33233 and 33241 are not reported with these codes.
The codes for the insertion of the initial system or replacement of the
existing generator and new lead(s) are:
Pacemaker
▲33206New generator and right atrial lead
▲33207New generator and right ventricular lead
▲33208New generator and right atrial and ventricular leads
Defibrillator
▲33249New generator and lead(s) in right atrium and/or ventricle
Notes:
– Report ▲33233 (pacemaker) or ▲33241 (defibrillator) when an
existing generator is removed. An exception occurs for an upgrade
from single pacemaker to dual pacemaker; report 33214, which includes removal of existing generator, a new lead, and a new generator.
The codes for an extraction of transvenous leads are:
33234 Single lead pacemaker system, atrial or ventricular
33235 Dual lead pacemaker system
33244 Defibrillator, one or more leads
The codes for the repair of pacemaker/defibrillator electrodes are:
▲33218 Single electrode
▲33220 Dual electrodes
The codes for the insertion of right atrial or ventricular pacemaker/
defibrillator lead(s) are:
33216 Single lead
33217 Two leads
The codes for the insertion of left ventricular lead (includes pocket revision) are:
▲33224 Attach to existing pacemaker or defibrillator generator
+▲33225Attach at time of insertion of new pacemaker/defibrillator
generator
The best way to evaluate the new and revised codes is to group them
according to the procedures performed.
16
AAPC Coding Edge
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Feature
Multi-lead System
The codes for repositioning of the lead(s)
are:
33215 Reposition of right atrial or right
ventricular lead
▲33226Reposition of left ventricular lead
Notes:
– Codes 33215 and 33226 include removal
and replacement of the existing generator.
– Code 33215 x 2 is reported when both
right atrial and right ventricular leads are
repositioned.
The codes for the revision/relocation of
pocket are:
33222 Pacemaker
33223 Defibrillator
Notes:
– Do not use these codes for revision of pocket during replacements
to accommodate a new generator.
The codes for the insertion/replacement of temporary pacemaker
lead(s) are:
33210 Single chamber lead
33211 Dual chamber leads
Notes:
– To report during a generator change, the patient must be documented as pacemaker dependent.
Pacemaker/defibrillator device evaluation codes 93279-93299 are
included with codes 33206-33249 and should not be reported together. Defibrillation threshold testing (93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination)
at time of initial implantation or replacement or 93641 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of
arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator)
may be reported when performed with defibrillator insertion/replacement procedures.
Also this year, 71090 is deleted: Fluoroscopy is now included in
33206-33249. If no lead work is performed other than inspection
with fluoroscopy, report 76000 Fluoroscopy (separate procedure), up
to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy).
18
AAPC Coding Edge
Coding Example:
PROCEDURE: Dual pacemaker
pulse generator exchange.
PREPROCEDURE DIAGNOSIS:
Complete heart block, pacemaker battery depletion.
PROTOCOL: Via a transfemoral venous approach, a temporary pacer is
placed fluoroscopically with the lead
tip in the RV and activated. The left
chest is prepped and draped in sterile
fashion. An incision is made over the
pulse generator and generator, and redundant leads are removed from the
pocket. The leads are disconnected from the pulse generator tested. The lead thresholds are adequate but an insulation breach of the
right ventricular lead is repaired with a kit. A new dual generator is
placed and attached to the RV and RA leads. The temporary pacer is removed.
The correct coding is:
33210 Insertion or replacement of temporary transvenous single
chamber cardiac electrode or pacemaker catheter (separate
procedure)
33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system
33218 Repair of single transvenous electrode, permanent pacemaker
or pacing cardioverter-defibrillator
The temporary pacer is separately coded because the patient was pacer dependent (33210). Removal of the old generator and placement
of the new generator are bundled together into a single code (33228);
therefore, you should not separately report 33233 Removal of permanent pacemaker pulse generator. The repair of a single lead (33218) is
reported, as well. Fluoroscopy is included in all codes 33206-33249
and should not be reported separately.
ZHealth©2011
David Dunn, MD, is vice president of ZHealth. He oversees physician coding
and participates as an instructor for ZHealth educational programs and is a contributor to Dr. Z’s Medical Coding Series. A graduate of Texas A&M University, he
completed his M.D. at the University of Texas, his surgical residency at Scott &
White Hospital, and his vascular surgery fellowship at Baylor College of Medicine. A diplomat of the American Board of Surgery, Dunn is also certified in Vascular Surgery. He is a fellow of the American College of Surgeons, a member of
the Southern Association for Vascular Surgery, and president-elect of AAPC’s National Advisory
Board (NAB).
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Professional
Feature
By Marcella Bucknam, CPC, CPC-H, CPC-P, CPC-I, CCC, COBGC, CCS-P, CCS
Overcome Coders’
TOP 10
Compliance Concerns
Part 1: Make numbers 10 through
six part of your compliance plan.
No matter what your specialty or the size of your practice, certain
issues should be part of your compliance plan. Over the next two
months, we will focus on the top 10 compliance concerns for a physician practice. You can tailor this list using additional information
from the Office of Inspector General’s (OIG) work plan (http://oig.
hhs.gov/reports-and-publications/workplan/index.asp), your specialty societies, and your own experience to develop a plan that will
effectively address compliance issues in your office.
Resource Tip: For more information on how to incorporate the 2012 OIG Work Plan into your
compliance plan, see Jillian Harrington’s, MHA, CPC, CPC-P, CPC-I, CCS-P, article on
page 36, “Hospitals: Set a Course for Compliance,” in this issue of Coding Edge, and check out
“Make the 2012 OIG Work Plan Work for You” on page 20 of January’s issue.
No. 10: Certifying Home
Health and Ordering DME
In 2010, Medicare and the federal government made clear they are
cracking down on fraud, waste, and abuse in home health and durable medical equipment (DME), and that they expect physicians and
non-physician practitioners (NPPs) who order these services to assist them in the effort. They are also willing to hold ordering providers responsible for assuring the medical necessity for these services and supplies.
Ordering providers are now required to personally see the patient before certifying the need for home health care, or for ordering (or reordering) DME. The ordering provider must also keep a copy of the
order in the patient’s medical record. This is a logical requirement
for most cases, but consider, for example, an otherwise healthy amputee who needs a DME order to replace the battery in his wheelchair. That patient must now wait for an appointment before he can
get the DME he needs.
For home health services, the certifying provider must document a
face-to-face encounter with the patient, related to the condition for
which home health services are ordered, within 90 days prior to, or
30 days after, initiation of home health care services. Physicians must
certify that these services are needed, but an NPP in the same spe20
AAPC Coding Edge
cialty and practice may see the patient and document the encounter. The certifying physician must specify that the patient was seen,
and how the patient’s clinical condition supports a homebound status and the need for skilled services. These rules apply to new certifications. Re-certifications may be done without a face-to-face visit.
Don’t forget to bill Medicare for these certifications. Use G0180
Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts
with home health agency and review of reports of patient status required
by physicians to affirm the initial implementation of the plan of care
that meets patient’s needs, per certification period for an initial certification and G0179 Physician re-certification for Medicare-covered
home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports
of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per re-certification
period for re-certification.
DME is any equipment (excluding prosthetics and orthotics) that is
reusable and is not typically used for people without a medical condition. Examples include:
• Wheelchairs (and wheelchair batteries)
• Crutches, walkers, and canes
• Bedpans
• Diabetes treatment supplies (like monitors)
• Lymphedema pumps
• Heat lamps
• Alternating pressure pads and mattresses
The patient must have had a face-to-face visit with the ordering physician or NPP within the last six months. This applies to all DME orders for Medicare patients, including replacement parts or replacement equipment. Under federal law, providers must see the patient before these orders are written, even when this is expensive or inconvenient. Failure to follow these rules could result in federal prosecution.
No. 9: Grading E/M on a Curve
The OIG analyzes billing trends and patterns for providers billing
evaluation and management (E/M) codes by comparing billing pat-
Feature
Ordering providers are now
required to personally see the
patient before certifying the need
for home health care or for
ordering (or re-ordering) DME.
terns to a bell-shaped curve of billing levels by other providers. The
analysis considers the practitioner’s specialty, type of service provided, setting, patient status, and the service’s complexity, and compares this to claim information for similar practices and patients.
Practitioners who fall outside the curve will have their documentation and claims scrutinized more closely for errors or fraud.
You can find standard bell curve information for your specialty by
viewing the Part B National Summary Data file, found on the CMS
website (www.cms.gov/NonIdentifiableDataFiles/03_PartBNationalSummary​
DataFile.asp). By comparing your own E/M utilization rates against
the national average, you can determine if this may be an issue for
your practice.
If you find that you’re an outlier, don’t panic. First, consider your
practice. Your curve may be appropriate based on patient type or
subspecialty. Then, check your documentation. If the documentation supports the levels you’re billing, you’re probably OK. Be sure to
check your documentation for medical necessity. Do the notes seem
appropriate to the patient’s problems? If so, there’s probably nothing
to worry about, except the cost of extra scrutiny.
No. 8: E/M Services in the
Global Surgical Period
This may be a bigger potential problem for non-surgeons than for
surgeons, especially for those who don’t know what’s included in the
global package.
The packaged surgical payment includes one related E/M service
on the day of, or day before, surgery. This includes the history and
physical prior to surgery, no matter when it is done. The service is not
separately billable—even if performed by another physician—unless there is a medically necessary clearance prior to the surgery. Physicians providing preoperative E/M services without adequate documentation of medical necessity are violating the global package.
The package also includes all typical follow-up care and—for Medicare and other payers that use the Medicare definition of the surgical
package—all care of complications that doesn’t require a return to
the operating room. This includes pain management, unless there is
adequate documentation of complex or acute on chronic pain issues
that require specialty management. Surgeons are expected to round
on their patients after surgery, even if a specialist manages the patient’s other problems after surgery.
Services for care of pre-existing or co-morbid acute or chronic conditions are not included in the global package. Care of any underlying disease process that created the need for surgery also is separately billable unless the condition was cured by the surgical procedure.
Care of a new, unrelated condition that arises in the postoperative
period also can be billed separately; but documentation of these separate conditions and a note that focuses on the separate conditions
is necessary. Don’t use any components that would be bundled (e.g.,
examination of the operative wound) to support the level of the separately billable service.
Be sure you know the global period of the surgical procedures you
bill. Many codes have had changes in the global periods, with resultant changes in their relative value units (RVUs). If a procedure has
been changed from 90 days to 0, you can be sure reimbursement has
also been reduced, and you will need to bill those post-op visits to
maintain your revenue.
No. 7:
Error-prone Providers
The OIG will use Comprehensive Error Rate Testing (CERT) program data from the past four years to identify error-prone providers
and look more closely at their claims. The OIG is defining an errorprone provider as any provider with an identified billing error during
the program period. This includes any of the following:
• Wrong CPT® code
• Wrong ICD-9-CM code
• Medical necessity errors
• Wrong date of service
• Missing or incomplete documentation (including nonresponse to requests for documentation)
Do not ignore CERT requests for documentation, and review documentation before you send it to CERT. Challenge any CERT findings you feel are in error. A clean CERT report will take one issue
off your plate.
www.aapc.com
February 2012
21
To discuss this
article or topic, go to www.aapc.com
Feature
No. 6:
Place of Service Errors
Of particular concern to
physician practices are services
billed as office visits (POS 11)
that were actually performed
in hospital outpatient locations
(POS 22).
We’ve known place of service (POS) was a concern of Medicare’s
for several years, and the 2012 OIG Work Plan has several items addressing this. Of particular concern to physician practices are services billed as office visits (POS 11) that were actually performed in hospital outpatient locations (POS 22). Services performed in hospital
outpatient locations are reimbursed to physicians at a lower rate than
they are in physician offices. Billing POS 11 in error is considered
duplicate billing. For more information, see MLN Matters® SE1104
(www.cms.gov/MLNMattersArticles/Downloads/SE1104.pdf).
For hospitals, the big POS issue is related to the medical necessity for
admissions, especially short admissions. Medicare has advised that
if the patient could be treated and discharged within 48 hours, the
patient should be in observation status rather than being placed in
inpatient status.
Next month: We’ll continue with the top five compliance concerns
for a physician practice, with tips for effective compliance in your
practice.
Marcella Bucknam, CPC, CPC-H, CPC-P, CPC-I, CCC, COBGC, CCS-P, CCS, is the manager of compliance education for a large university practice group. She is the long-time consulting
editor for General Surgery Coding Alert, and has presented at five AAPC National Conferences.
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AAPC Coding Edge
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Professional
Hot Topic
By G.J. Verhovshek, MA, CPC
How Much Direct Supervision Does 95165 Require?
Look to incident-to rules for clarity.
Question: I am trying to determine what level of physician supervision is required for “supervision of preparation and provision of antigens for allergen immunotherapy” (95165).
The Medicare Physician Fee Schedule assigns a “Physician Supervision” requirement of 9,
or “concept does not apply.” How do I interpret this? Does the physician have to be in the office during allergy serum preparation?
Answer: Antigen preparation, as described by 95165 Professional services for the supervision of preparation and provision of
antigens for the allergen immunotherapy; single or multiple antigens (specify number of doses) is a therapeutic service, so requirements for physician supervision of diagnostic procedures—as
described by Medicare’s Physician Fee Schedule (MPFS)—do
not apply. For Medicare patients in the physician office, services performed by a qualified non-physician practitioner (NPP)
must meet incident-to guidelines.
For a service to qualify as incident-to:
• The NPP must be licensed or certified to provide
professional health care services in the state where the
physician practice is located.
• Generally, the NPP must be a full-time, part-time,
or leased employee of the physician or physician
group practice. (In limited cases, the NPP may be an
independent contractor of the physician or physician
group practice.)
• The NPP must provide services as an integral part of and
incident-to the physician’s services.
• The NPP must provide such services under the direct
supervision of the physician.
Per Medicare rules, direct supervision means the supervising
physician must be present in the office suite and immediately available to furnish assistance and direction throughout the
performance of the procedure. The physician does not need to
be present in the room during the procedure, but must not be
performing another procedure that cannot be interrupted, and
must not be so far away that he or she could not provide timely
assistance. Documentation should substantiate that the physician was present, on site, to supervise the mixing of the antigens.
Incident-to rules do not apply to a hospital setting. Per 2011
Hospital Outpatient
Prospective Payment
System (OPPS) Final Rule (http://edock​
e­ t.access.gpo.gov/2010/
p d f/2010 -27926.p d f ),
therapeutic services in
an outpatient setting
may be provided:
• Under the direct
supervision of an
MD or DO, or
• Under the direct
supervision
of a physician
assistant, nurse
practitioner,
clinical nurse
specialist, certified nurse-midwife, licensed clinical
social worker, or clinical psychologist who could
personally furnish the service “in accordance with State
law.” The supervising NPP must be privileged by the
hospital to perform the services he or she supervises,
and must abide by any applicable hospital physiciancollaboration or supervision requirements.
Note: Medicare physician supervision requirements do not
apply to hospital inpatient services. For inpatient services,
the Centers for Medicare & Medicaid Services (CMS) defers
to hospital policy and Joint Commission (formerly JCAHO)
standards.
iStockphoto©Eric Hood
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
Documentation should substantiate that the physician was
present, on site, to supervise the mixing of the antigens.
www.aapc.com
February 2012
23
ICD-10 Roadmap
By Jana Purrell, CPC, CPC-I, CEMC
Stabilize ICD-10 Coding for
Faulty Myocardial Infarction
Clean claims require a healthy
balance of anatomy and pathophysiology knowledge as
well as proper documentation.
Both ICD-9 and ICD-10 coding systems classify MIs as either ST
elevation (STEMI) or non-ST elevation (NSTEMI). The STEMI
usually results in a blockage of a coronary artery, indicated by a dramatic rise in cardiac enzymes in the blood and, eventually, Q wave
changes shown on a cardiogram. The NSTEMI generally occurs
with symptoms of unstable angina, which causes a smaller rise in the
cardiac enzymes without a resulting shift in the Q wave of the cardiogram.
A myocardial infarction (MI) or acute myocardial infarction (AMI),
commonly referred to as a heart attack, occurs when one or more coronary arteries that carry blood to the heart are blocked. Symptoms
include chest pain, pressure, or tightness, which may move into the
jaw, neck, throat, or arm(s). Patients also may experience shortness
of breath, excessive sweating, and/or indigestion or burning in the
throat and/or chest. MI is a medical emergency. Left untreated, it
can cause permanent harm to the heart muscle, brain damage, and
death within a short time.
MI is part of the leading cause of death in the United States: Approximately 450,000 people die from coronary disease per year, according to the America Heart Association.
The good news is that the increase in intensive/coronary care units
in communities, along with faster diagnosis of MIs resulting in early
reperfusion therapy use, has improved outcomes for many patients.
Early treatments now include administration of fibrinolytic agents
(i.e., tissue plasminogen activator (tPA)) in the emergency setting to
break up the clots that have built up in the arteries, or early percutaneous coronary interventions (PCI), such as angioplasty or coronary
artery bypass grafting (CABG).
Must-knows for Coding MI
Become Familiar with
Types and Classifications
There are two types of acute MI:
1. Transmural infarcts are associated with a build up of plaque in
a major coronary artery. They generally extend through the
whole thickness of the heart muscle.
2. Subendocardial infarcts involve the wall of the left ventricle, the
ventricular septum, or the papillary muscles. They are thought
to be caused by a narrowing of the coronary arteries.
24
AAPC Coding Edge
To code an MI in ICD-10, you will need to know:
• the location of the infarct (anterior, inferior, or other);
• initial or subsequent episode; and,
• STEMI or NSTEMI.
Codes for the STEMI are also based on the coronary artery involved:
• Anterior MI (I21.0 ST elevation (STEMI) myocardial
infarction of anterior wall) is either left main, left anterior
descending, or other coronary artery.
• Inferior MI (I21.1 ST elevation (STEMI) myocardial infarction
of inferior wall) breaks down to right coronary or other
coronary artery.
• STEMI of other sites involve infarct of the left circumflex
artery or other sites.
The relevant ICD-10-CM codes for MI are:
I21.01
ST elevation (STEMI) myocardial infarction involving the left
main coronary artery
I21.02
ST elevation (STEMI) myocardial infarction involving the left
anterior descending coronary artery
I21.09
ST elevation (STEMI) myocardial infarction involving other
coronary artery of anterior wall
I21.11
ST elevation (STEMI) myocardial infarction involving right
coronary artery
I21.19
ST elevation (STEMI) myocardial infarction involving other
coronary artery of inferior wall
I21.21
ST elevation (STEMI) myocardial infarction involving left
circumflex coronary artery
ICD-10 Roadmap
If only STEMI or transmural MI is documented without mention
of the site, you should ask the provider as to the site.
I21.29
I21.3
I21.4
I22.0
I22.1
I22.2
I22.8
I22.9
I25.2
ST elevation (STEMI) myocardial infarction involving other sites
ST elevation (STEMI) myocardial infarction of unspecified site
Non-ST elevation (NSTEMI) myocardial infarction
Subsequent ST elevation (STEMI) myocardial infarction of
anterior wall
Subsequent ST elevation (STEMI) myocardial infarction of
inferior wall
Subsequent non-ST elevation (NSTEMI) myocardial
infarction
Subsequent ST elevation (STEMI) myocardial infarction of
other sites
Subsequent ST elevation (STEMI) myocardial infarction of
unspecified site
Old myocardial infarction
Look to Guidelines for Assistance
STEMI of an unspecified site is reported I21.3. According to ICD10-CM Official Guidelines for Coding and Reporting, I21.3 is the
default for the unspecified term “acute myocardial infarction.” As
with ICD-9, you should use unspecified codes only as a last resort:
If only STEMI or transmural MI is documented without mention
of the site, you should ask the provider as to the site.
Note that the timeframe for the acute myocardial infarction in
ICD-10 has changed from eight weeks to four weeks. This is a major change from ICD-9.
ICD-10-CM Official Guidelines for Coding and Reporting states,
“For encounters after the 4 weeks time frame and the patient requires continued care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from
category I21. Otherwise, code I25.2 Old myocardial infarction, may
be assigned for old or healed myocardial infarction not requiring
further care.”
The ICD-10-CM guidelines also provide guidance on coding subsequent MI: “A code from category I22, Subsequent ST elevation
(STEMI) and non ST elevation (NSTEMI) myocardial infarction, is
to be used when a patient who has suffered an AMI has a new AMI
within the 4 week time frame of the initial AMI. A code from cat-
egory I22 must be used in conjunction with a code from category
I21. The sequencing of the I22 and I21 codes depends on the circumstances of the encounter.”
For example, if a patient is in the hospital being treated for an AMI
and experiences another AMI, code I21 ST elevation (STEMI) and
non-ST elevation (NSTEMI) myocardial infarction would be listed
first as the reason for the admission, with code I22 Subsequent ST
elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction listed as secondary. If a patient were discharged from the
hospital after being treated for an AMI and suffers another AMI
that requires admission, I22 would be listed first, followed by I21.
In this case, I21 shows that the patient is still within the four-week
time frame from the initial MI to support subsequent MI code use.
Also new for ICD-10 is guidance to use additional codes, if applicable, to indicate:
• Tobacco status (history of (Z87.891 Personal history of
nicotine dependence), exposure to (Z77.22 Contact with and
(suspected) exposure to environmental tobacco smoke (acute)
(chronic)), occupational exposure (Z57.31 Occupational
exposure to environmental tobacco smoke), dependence (F17.Nicotine dependence), or use (Z72.0 Tobacco use)
• Z92.82 Status post administration of tPA (rtPA) in a different
facility within the last 24 hours prior to admission to the current
facility
• Z68 Body mass index (BMI)
Complications following an MI are now combined into one code
range (I23 Certain current complications following ST elevation
(STEMI) and non-ST elevation (NSTEMI) myocardial infarction
(within the 28 day period)), with guidance that a code from this category must be used with a code from either the initial (I21) or subsequent (I22) MI category. The complication code (I23) should be
listed first if that is the reason for the visit, but should be listed second if the complication occurs during the encounter for the MI.
Jana Purrell, CPC, CPC-I, CEMC, has over 30 years of clinical and management experience in a variety of health care settings. She is the practice administrator for Mid Coast Medical Group in Brunswick, Maine, which is made up of
12 hospital-based physician practices with more than 60 multi-specialt y
providers.
www.aapc.com
February 2012
25
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Cardiology
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Dermatology
• In-depth coding guidelines and hands-on coding cases
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• Commonly coded dermatology conditions
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OB / GYN
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• Commonly coded conditions for OBGYN
Orthopaedics
• In-depth coding guidelines and hands-on coding cases
• Documentation issues in orthopaedics
• Injury coding for orthopaedics
• Commonly coded orthopaedic conditions
Pediatrics
• In-depth coding guidelines and hands-on coding cases
• Injury and fx coding for emergency department
• Documentation issues in emergency department
• In-depth coding guidelines and hands-on coding cases
• Neoplasms for pediatrics
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ENT (Otolaryngology)
Urology
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• In-depth coding guidelines and hands-on coding cases
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Family Practice / Internal Medicine
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www.aapc.com/icd-10
Cover Story
Optimize Adjacent Tissue Transfer/
Rearrangement Reimbursement
Check location and combined areas to capture separately reportable procedures.
By Ken Camilleis, CPC, CPC-I, CMRS
An adjacent tissue transfer (CPT® 14000-14350) relocates a flap
of healthy skin from a donor site to an adjacent laceration, scar,
or other discontinuity. A portion of the flap is left intact to supply
blood to the grafted area. Adjacent tissue transfer/rearrangement (ATT/R) may be for repair of traumatic skin wounds, lesion
excision, or rearrangement/reconstruction of tissue by Z-plasty,
W-plasty, V-Y-plasty, rotation flaps, advancement flaps, or other
methods.
CPT® assigns ATT/R procedure codes by anatomic site, and by
the combined area (in square centimeters) of the defect to be
repaired (the primary defect) and the defect created by the tissue
transfer (the secondary defect). ATT/R procedures with a total
area of more than 30 sq cm are reported using the “any site”
codes 14301-14302.
14000
14001
14020
14021
14040
14041
14060
14061
14301
28
Adjacent tissue transfer or rearrangement, trunk; defect 10 sq
cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, scalp, arms and/or
legs; defect 10 sq cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, forehead, cheeks,
chin, mouth, neck, axillae, genitalia, hands and/or feet; defect
10 sq cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, eyelids, nose, ears
and/or lips; defect 10 sq cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, any area; defect
30.1 sq cm to 60.0 sq cm
AAPC Coding Edge
+14302
14350
each additional 30.0 sq cm, or part thereof (List separately
in addition to code for primary procedure)
Filleted finger or toe flap, including preparation of recipient site
As an example, the surgeon repairs a defect on the chest using
ATT/R. The primary defect measures 4 sq cm, while the secondary defect (resulting from creation of the tissue flap) measures 9
sq cm. Per CPT®, “The primary defect resulting from the excision
and the secondary defect resulting from flap design to perform
the reconstruction are measured together to determine the code.”
In this case, total area is 13 sq cm (4 sq cm + 9 sq cm). Because
the defect is located on the trunk, the correct code is 14001.
Include Same-location Excision, Debridement, and Repairs
Per CPT® instructions, ATT/R procedures include excisions at
the same location—for instance, to revise a scar or to remove a
benign or malignant lesion.
CPT ® Assistant (July 2008) provides the following example: A
physician excises a 1.5 cm lesion on the cheek with an excised diameter of 1.8 cm (primary defect, approximately 3.2 sq cm) and
performs an adjacent tissue transfer (flap dimension of 1.4 cm x
3.0 cm, which equals a 4.2 sq cm secondary defect). Based on
the total area of the primary and secondary defects (7.4 sq cm)
and the location (cheek), the correct code is 14040. The lesion
excision is included in the tissue transfer and is not separately
reported.
In a second example, a patient’s nostril is retracted secondary to
a scar. The scar is excised, and an 11 sq cm dorsal nasal flap is
used to repair the 2 sq cm defect resulting from the scar excision. Based on the total area (13 sq cm) and location (nose), the
correct code is 14061. The ATT/R code includes scar excision at
the same location.
Expert
Cover Story
If an excision is performed at a separate
location from an ATT/R, you may report
that excision independently.
According to the National Correct Coding Initiative (NCCI) Policy
Manual for Medicare Services (chapter 3), “Debridement necessary to perform a tissue transfer procedure is included in the
procedure. It is inappropriate to report debridement (e.g., CPT®
codes 11000, 11042-11047, 97597, 97598) with adjacent tissue
transfer (CPT® codes 14000-14350) for the same lesion/injury.”
As well, NCCI edits prohibit separate reporting of related repairs
(12001-13160) with ATT/R procedures. The NCCI Policy Manual
clearly states, “12001-13160 should not be reported separately
with CPT codes 14000-14350 for the same lesion or injury.”
Note: Medicare contractors must observe NCCI guidelines, but
private payers may reimburse medically necessary complex closures (13100-13160) to repair a secondary defect in addition to
an ATT/R. Check with your payer for its policies.
Grafts Call for Separate Coding
As CPT ® Assistant (July 2008) explains, “Sometimes a tissue
transfer or rearrangement procedure creates an additional defect
that must be repaired. If a skin graft or another flap is necessary
to close a secondary defect, this should be reported separately.”
The NCCI Policy Manual concurs, stating, “Skin grafting in
conjunction with a repair or adjacent tissue transfer is separately
reportable if the grafting is not included in the code descriptor of
the adjacent tissue transfer code.”
For example, the surgeon excises a 5 cm malignant lesion with
0.5 cm margins from the neck (for an excised diameter of 7 cm or
38.5 sq cm). A 64 sq. cm transposition flap is used to close the
defect (primary defect + secondary defect = 102.5 sq cm). The
flap donor site is partially closed, but there is a remaining 16 sq
cm defect, which requires a split-thickness skin graft.
To report the ATT/R, begin with 14301, which describes any area
30.1 to 60.0 sq cm. For the remaining 42.5 sq cm (102.5 – 60 =
42.5), report two units of add-on code 14302, which describes
each additional 30 sq cm, or part thereof. The lesion excision is
included in the adjacent tissue transfer and isn’t coded separately.
The split thickness autograft to repair the remaining 16 sq cm
defect may be separately reported using 15120 Split-thickness
autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia,
hands, feet, and/or multiple digits; first 100 sq cm or less, or 1%
of body area of infants and children (except 15050).
Don’t Over-code Repairs
Adjacent tissue transfer codes do not apply when the rearrangement of traumatic wounds incidentally results in an ATT/R configuration (e.g., Z-plasty, W-plasty), according to CPT® guidelines.
If the surgeon only debrides and closes a primary defect (for
example, using staples, sutures, or adhesives), choose an appropriate repair code (12001-13160). For instance, if the surgeon undermines the adjacent tissue to achieve closure without additional
incisions, even if the surgeon advances flaps of skin toward each
other, you would report a complex closure (13100-13160), rather
than an ATT/R, because the flap advancement by itself is not sufficient to code an ATT/R.
Report ATT/R (14000-14350) only if the surgeon freed any tissue
from another site or from around the damaged area, and transplanted or rearranged the tissue to overlay and repair the wound.
www.aapc.com
February 2012
29
Cover Story
Key Terms for Adjacent Tissue
Transfers, Flaps, and Grafts
Note: For those payers who still require its use, append
modifier 51 Multiple procedures to the lesser-valued
procedure (in this case, 15120). Some payers may instead
require you to apply modifier 59 Distinct procedural service,
although this is not required by either CPT® or NCCI guidelines. Check with your payer for its requirements.
Apply Modifiers to Indicate Unique Locations/Sessions
If an excision is performed at a separate location from an
ATT/R, you may report that excision independently. For
instance, the physician excises a lesion from the cheek with
adjacent tissue transfer (e.g., 14040). She also excises a
second, benign lesion with an excised diameter of 0.7 cm
from the left arm, which she closes by simple repair.
Because the second excision occurs at a separate location
not associated with the ATT/R, you may report it separately
using 11401 Excision, benign lesion including margins,
except skin tag (unless listed elsewhere), trunk, arms or legs;
excised diameter 0.6 to 1.0 cm (simple repair is bundled to
the excision procedure). Append modifier 59 to 11401 to
alert the payer that the excision occurred in a unique location, separate from any excision associated with the ATT/R
(14040).
Finally, you may separately report excision of a benign
(11400-11446) or malignant (11600-11646) lesion that occurs during a different operative session. For example, the
physician excises a 3.7 cm benign lesion from the patient’s
left arm on April 1. Five days later, on April 6, the physician performs an ATT/R of 18.4 sq cm to repair the wound
created by the excision. Such a scenario could occur if the
pathology report had not come back, and the physician
wanted to be sure the margins were negative before closing
the primary defect.
Proper coding for this scenario is 11404 Excision, benign
lesion including margins, except skin tag (unless listed
elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0
cm for the service on April 1, and 14021 for the service
on April 6. Because the ATT/R occurred during the 10-day
global period of the excision, you should append modifier 58
Staged or related procedure or service by the same provider
during the postoperative period to 14021. If the ATT/R was
performed following the end of the global period (e.g., on
April 13), a modifier would not be required for 14021.
Kenneth Camilleis, CPC, CPC-I, CMRS, is a medical coding and billing
specialist whose present focus is coding education. He is a full-time Professional Medical Coding Curriculum (PMCC) instructor and part-time educational consultant. Camilleis is the 2012 member development officer
and an ICD-10 Advisory Committee member for his local chapter.
Advancement flap – A flap carried to its new position by a sliding process (also
known as sliding flap).
Burow’s graft – A type of adjacent tissue transfer accomplished by a full-thickness skin graft with a rounded or elliptical shape.
Cytoreduction surgery – See debulking.
Debulking – The surgical removal of part of a malignant tumor to enhance the
effectiveness of cancer treatment such as chemotherapy or radiation (also
known as cytoreduction surgery).
Defect – A discontinuity of the skin caused by surgical intervention.
Donor site – The anatomic site from which healthy skin is taken.
Free flap – An island flap detached from the donor site and reattached at the
recipient site by microvascular anastomosis.
Full-thickness skin graft – A skin graft involving the epidermis and all of the
dermis.
Island flap – A flap consisting of skin and subcutaneous tissue with a pedicle
composed of only nutrient vessels (also known as island pedicle flap).
Limberg flap – See rhomboid flap.
Myocutaneous flap – An autologous graft consisting of both skin and muscle
tissue from a donor site.
Primary defect – The wound from the initial excision of the lesion.
Random pattern flap – A myocutaneous flap with a random pattern of arteries.
Recipient site – The site on the body adjacent to the excised lesion.
Rhomboid flap – A random pattern flap that can be raised on any or all corners
of a parallelogram configuration typically of 120 and 60 degrees (also known as
a Limberg flap).
Rotation flap – A semicircular pedicle flap whose width is increased by forming an arc with the edge distal to the primary defect. The flap is subsequently
rotated into the defect on a fulcrum point with a counter-incision made at the
base of the arc to increase the mobility of the flap.
Secondary defect – The wound resulting from the flap arrangement.
Sliding flap – See advancement flap.
Split-thickness skin graft – A skin graft involving the epidermis and part of the
dermis.
Stroma – The supporting tissue (matrix) of an organ.
Tissue approximation – a method of replacing sutures with material or substance that blends in better with the skin and provides faster healing of defects.
Undermining – A process of using a surgical instrument to separate skin and
mucosa from its underlying stroma so the tissue can be stretched or moved to
overlay a defect or wound.
V-Y-plasty – A technique used to overlay surgical defects or lengthen tissue
whereby a V-shaped incision is made, the segments are slid apart and the Vpatterned skin is used to cover the incised area as a Y-shape.
W-plasty – A plastic surgery procedure to prevent contracture of a straight-line
scar, such that the edges of the flap are trimmed in the shape of the letter W
and closed in a zigzag pattern, with the triangular remnants intertwined for
suturing.
Z-plasty – A technique used to improve appearance of a scar by elongating it
or rotating the scar tension line via a Z-shaped incision made along the line of
greatest tension or contraction, raising triangular flaps on opposite sides of the
two ends, and then transposing them.
30
AAPC Coding Edge
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Expert
Feature
By David Zielske, MD, CPC-H, CIRCC, CCC, CCS, RCC
2012 Brings All-inclusive Codes for Interventional Radiology
New, more concise codes facilitate spot-on coding for all components
of vascular and nonvascular procedures.
M
any interventional radiology code changes over the past
several years have resulted in the creation of a single
code to describe what was previously described with multiple codes. This trend continues in CPT® 2012 with new bundled codes describing renal angiography, vena cava filter intervention, paracentesis, and other nonvascular interventions.
Renal Angiography
Last year, renal angiography was described by catheter
placement(s) (e.g., 36245, 36246), radiological supervision
and interpretation (e.g., 75722, 75724), and imaging for accessory renal artery evaluation (e.g., 36245-59, 75774). In
2012, codes 75722 and 75724 are deleted. New codes 3625136254 include main renal artery catheter placement(s), radiological supervision and interpretation, and accessory or superselective branch renal arterial catheter placement and imaging:
36251
Selective catheter placement (first-order), main renal
artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter
placement(s), fluoroscopy, contrast injection(s), image
postprocessing, permanent recording of images, and
radiological supervision and interpretation, including
pressure gradient measurements when performed, and
flush aortogram when performed; unilateral
36252
bilateral
36253 Superselective catheter placement (one or more second
order or higher renal artery branches) renal artery and
any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy,
contrast injection(s), image post processing, permanent
recording of images, and radiological supervision and interpretation, including pressure gradient measurements
when performed, and flush aortogram when performed;
unilateral
36254 bilateral
Codes 36251 and 36252 describe selective (first-order catheter placement only) of unilateral or bilateral renal arteries (including accessory renals off the aorta and iliac artery). Codes
36253 and 36254 describe superselective (second order or
32
AAPC Coding Edge
higher) catheter selection(s). Superselective renal angiography includes accessory renals off the aorta and iliac artery, but
also includes selection and imaging of multiple additional intrarenal branches.
Just one of these four codes should be billed per session, with
a single exception (see below). All codes include nonselective
imaging of the abdominal aorta (do not report 75625 Aortography, abdominal, by serialography, radiological supervision and
interpretation with 36251-36254), closure device imaging and
placement, conscious sedation, and pull-back pressure determinations (with wire or catheter) across the renal arteries to
evaluate the hemodynamic significance of identified arterial
abnormalities—3D reconstructions are also included. Basically, one code describes the entire procedure from puncture
to closure, when the procedure is for diagnostic imaging related to the renal arteries (and other imaging or intervention
is not performed).
Here are a few things not to do when reporting 36251-36254:
• Do not report a unilateral and a bilateral renal code
together.
• Do not report two bilateral codes together.
• Do not report two unilateral codes when selective and
superselective imaging is performed on one side of the
body.
• Do not code preliminary nonselective abdominal
aortography.
• Do not separately code catheter placements, imaging,
closure device placement, or conscious sedation.
The exception for submitting just one of codes 36251-36254
is if unilateral selective renal imaging is performed along
with contralateral superselective renal imaging. In this case
(which may occur in patients with suspected renal trauma),
both kidneys are evaluated by selective imaging. A bleeding
site is identified on one side, evaluated further with superselective imaging, and then treated with embolization therapy. Codes 36251 (unilateral, selective) and 36253 (unilateral, superselective) are both submitted with modifier 59 applied to code 36251 to demonstrate that the procedures are
performed on different sides of the body. The American Col-
Feature
Adrenal Glands
Left Kidney
Right Kidney
Vein
Artery
Inferior Vena Cava
Aorta
Ureters
Bladder
iStockphoto © Medical Art Inc.
lege of Radiology (ACR), Society of Interventional Radiology (SIR), and Society for Vascular Surgery (SVS) have made
this recommendation.
Coding example:
Procedure: The patient is a 48-year-old male with hypertension and abnormal renal Doppler. A 5-French sheath is placed
in the right common femoral artery, followed by placement
of a pigtail catheter into the aorta. Abdominal aortography
shows two right and three left renal arteries. All five vessels
are selected with an SOS catheter and imaging is performed.
Superselective imaging of both the right and left main renal arteries is performed followed by advancing the catheter
into the upper-pole, mid-pole, and lower-pole third-order renal artery branches with additional imaging. Pressure wire is
placed across the two questionable stenoses in right intrarenal
branches. The catheter and sheath are removed and the closure device placed.
Findings: Fibromuscular dyplastic changes are seen in the intrarenal branches, bilaterally. No hemodynamically significant stenosis is identified.
Coding: 36254 (describes the entire procedure)
Vena Cava Filters
Vena cava filters are placed as temporary or permanent devices
in the vena cava (inferior vena cava (IVC) and, rarely, the superior vena cava (SVC)) to trap blood clots traveling from the
extremities and prevent them from reaching the pulmonary
arterial circulation, causing pulmonary embolism and its sequelae. When a permanent filter is placed, it cannot be manipulated. Temporary filters, which are quite common today, can
be repositioned if they migrate and become ineffective, and
they can be removed when the risk of thromboembolism has
passed. If the risk remains or clot is seen in the filter, the temporary filter can stay as a permanent filter.
Three new codes for 2012, 37191-37193, bundle all component codes previously used for these procedures: catheter
placement(s), diagnostic venography, ultrasound guidance for
vascular access, guiding shots and confirmatory venograms,
and placement and deployment (or repositioning, removal) of
the vena cava filter. All fluoroscopy and ultrasound imaging
guidance is included.
37191
Insertion of intravascular vena cava filter, endovascular
approach including vascular access, vessel selection,
www.aapc.com
February 2012
33
Feature
New codes for destruction by a neurolytic agent of paravertebral
joint of the spine also now bundle imaging guidance ...
and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
37192
Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
37193
Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel
selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed Codes 37620 and 75940 are deleted for 2012.
Coding example:
Procedure: Patient is a 32-year-old male status post motor vehicle accident with pelvic fractures. Patient had temporary
IVC filter placed four weeks earlier and has now requested to
have it removed. Using ultrasound guidance for vascular access, a 10-French sheath is placed in the jugular vein. A catheter is advanced to the IVC and imaging performed, showing
a patent filter and vena cava. The filter legs do not appear to
penetrate the IVC wall. A snare is placed over the tip of the filter, and the sheath and snare are used to collapse and retrieve
the filter. This is pulled into the sheath, and the entire apparatus is removed from the jugular vein. Pressure and dressing
are applied.
Coding: 37193 (describes the entire procedure) Nonvascular Interventions
Several codes for nonvascular interventions also now bundle
imaging guidance.
New paracentesis codes describe drainage of abdominal fluid
for diagnostic or therapeutic reasons without imaging guidance (49082 Abdominal paracentesis (diagnostic or therapeutic);
without imaging guidance), with imaging guidance (49083 Ab-
dominal paracentesis (diagnostic or therapeutic); with imaging
guidance), and for peritoneal lavage with or without imaging
guidance (49084 Peritoneal lavage, including imaging guidance, when performed).
Codes 49080 and 49081 previously described paracentisis,
but have been deleted for 2012.
New codes for destruction by a neurolytic agent of paravertebral joint of the spine also now bundle imaging guidance (fluoroscopy or computed tomography (CT)):
64633 Destruction by neurolytic agent, paravertebral facet joint
nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
+64634 each additional facet joint (List separately in addition
to code for primary procedure)
64635 Destruction by neurolytic agent, paravertebral facet joint
nerve(s), with imaging guidance (fluoroscopy or CT);
lumbar or sacral, single facet joint
+64636 each additional facet joint (List separately in addition
to code for primary procedure)
As well, sacroiliac joint arthrography is now bundled with
anesthetic/steroid injection in a single code (27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when
performed), which also includes imaging guidance. The former imaging code 73542 is deleted in 2012. If a sacroiliac joint
injection does not include fluoroscopy or CT guidance, report 20552 Injection(s); single or multiple trigger point(s), 1 or 2
muscle(s) rather than 27096.
On a final note, vertebroplasty (22520-22522) now specifically includes biopsy of the same bone.
David Zielske, MD, CPC-H, CIRCC, CCC, CCS, RCC, is an interventional radiologist and president of ZHealth and ZHealth Publishing in
Brentwood, Tenn.
CPT® Clarifies AV Shunt/Fistula Coding
Physicians continue to perform increasingly complex interventions related to arteriovenous (AV) shunts/fistulas, which has caused
some confusion as to how to code some of these procedures. The American Medical Association (AMA) helps clarify correct coding for
these complex AV shunt/fistula interventions for 2012. Several well written paragraphs describing the procedures, along with the appropriate coding, can be found in CPT® 2012 and 2012 CPT ® Changes: An Insider’s View. These references should be reviewed closely
and applied to such cases in your practice.
34
AAPC Coding Edge
R
Official CMS Information for
Medicare Fee-For-Service Providers
The help you need – right here.
Get answers to Medicare Program
questions, and much more, from the
Medicare Learning Network ® (MLN).
http://go.cms.gov/mln-information
R
Official CMS Information for
Medicare Fee-For-Service Providers
We look forward to meeting you at
the AAPC National Conference in
Las Vegas, April 1-4, 2012.
Professional
Facility
By Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P
Hospitals:
Set a Course for Compliance
Use the 2012 OIG Work Plan to chart your hospital’s compliance plan.
L
ast month, we explained the U.S. Department of
Health & Human Services (HHS) Office of Inspector General’s (OIG’s) annual work plan, with details
about physician practice interests for 2012, from an audit
and evaluation perspective (January Coding Edge, “Make
the 2012 OIG Work Plan Work for You”). This month,
we’ll focus on the areas of interest for hospitals. By reviewing the same compliance items as the OIG, you’ll be more
likely to catch problems first, which allows you to manage
corrective action internally.
Several items in the 2012 Work Plan, aimed specifically at the hospital industry, are appearing for the first time.
These include:
Accuracy of Present-on-admission Indicators Submitted on Medicare Claims
The OIG is reviewing the accuracy of present-on-admission indicators as submitted on claims starting in October
2008. The Affordable Care Act has placed a payment reduction on hospitals that consistently submit high rates of
claims for hospital acquired conditions. Accurately coding
these claims is vital for providers to protect themselves from
these payment reductions.
Medicare Inpatient and Outpatient Payments to Acute Care Hospitals
This is a very broad-based review that seems to measure
compliance effectiveness or compliance best practices;
however, given the movement toward data-driven reviews
by recovery audit contractors (RACs) and the Centers for
Medicare & Medicaid Services (CMS), this may be a foray into predictive modeling by the OIG, as well. Results of
this review will be telling for the future of data-driven reviews in the OIG office.
Acute Care Hospital Inpatient Transfers to Inpatient Hospice Care
The OIG will review claims for inpatient stays when the patient was transferred to hospice care, and will examine the
relationship (either financial or common ownership) between the hospital and the hospice provider. They will also
examine reimbursement from Medicare when determined
36
AAPC Coding Edge
for similar transfers from the acute care setting to other settings. Although there is not an assumed conflict of interest,
OIG wishes to confirm that no such conflicts exist.
Hospice seems to be an area of focus for the OIG in the work
plan year: There is a second new review this year also dealing with hospice, nursing facilities, and conflict of interest.
Medicare Outpatient Dental Claims
This item refers not to dental offices, but to dental services
provided in the outpatient hospital setting. The OIG will
review outpatient hospital services to determine if dental
services in that setting were reimbursed according to Medicare guidelines.
Very few dental services are covered under the Medicare
program (typically, only items such as wiring secondary to
a jaw surgery or removal of teeth for radiation therapy). The
OIG has found significant overpayments were made for
dental services in the outpatient hospital setting in the past.
Hospitals may provide support services only to dentists for
these outpatient services, which can make billing confusing. This is an important item for hospitals to review; and
perhaps you might accomplish this by running billing reports by provider name.
Inpatient Rehabilitation Facilities
This is a general medical necessity review of inpatient rehabilitation facilities. The OIG is reviewing the appropriateness of admission, as well as the level of therapies being provided. This is a good opportunity for organizations to review their documentation to be assured it meets all minimal criteria for medical necessity support.
Critical Access Hospitals
There are always items in the work plan regarding critical
access hospitals (CAHs), but this is a new review. The OIG
will compare CAHs to other hospitals, specifically by size,
services, and distance from the hospitals. They also will
look at the CAHs’ patient load to determine numbers and
types of patients.
ASCs and Hospital Outpatient Departments:
Safety and Quality of Surgery and Procedures
There has been a significant increase in the number of sur-
To discuss this article or topic, go to
www.aapc.com
Facility
The OIG has found significant overpayments
were made for dental services in the outpatient
hospital setting in the past.
gical services provided in the ambulatory surgery center (ASC) setting in recent years. The OIG will be looking at
safety and quality of care data across
various settings (ASC, hospital outpatient, physician office, etc.).
End-stage Renal Disease: Multiple Items
There are three new items related to
end-stage renal disease (ESRD). Two
concern the new prospective payment
plan: The first reviews payments for
services provided to patients who are
paid under the new ESRD Prospective
Payment System (PPS); the second reviews payments for drugs paid under
the new program.
CMS is charged with monitoring the
quality of care provided to dialysis patients, and they manage this process through providing oversight and certification services to dialysis facilities. This third OIG review
will examine how well CMS is performing these oversight
services.
Medicare Payments for Herceptin
Herceptin is a chemotherapeutic drug, provided in a large
quantity vial, and the dosage is typically much less than
the amount provided. By Medicare guidelines, providers
are allowed to bill only the amount of medication actually administered, not the amount dispensed by the pharmacy (amount administered, plus the waste). In the past, some
facilities were billing for drug waste, as well. Review your
records to verify your billing for Herceptin to be sure this is
not an error you’re making.
Medicare Outpatient Payments for Drugs
This review looks at outpatient payments for drugs, specifically issues related to coding and incorrect units. They
mention chemotherapeutics twice in the review description, so although this is not a chemotherapy specific review,
chemotherapy does seem to be a focus.
iStockphoto©Sandra Nicol
Look at your units on drug coding. This is an area where errors can be easily made, which can result in large overpayments (or underpayments).
Examine More In-depth
The aforementioned areas covered in the 2012 HHS OIG
Work Plan as well as many other items, new and old, in the
plan will affect hospitals. Please take the time to review the
work plan at http://oig.hhs.gov/reports-and-publications/workplan/
index.asp#current to build your auditing and monitoring plan
around it. Examine the areas the OIG is examining to learn
more about the level of compliance in your organization.
Their compliance roadmap will give you great insight into
where they are going for the year. Use it to plot out an auditing map for your hospital to help keep you on track during
this incredibly complex time in our industry.
Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, serves as
a clinical technical editor for Ingenix/OptumInsight, and has nearly
20 years of experience in the health care industry. She is a former
chief compliance officer and chief privacy official. She teaches CPT®
coding as an approved AAPC instructor and is a former member of
AAPC’s ICD-10 curriculum development team. She holds a bachelor’s degree in health care administration from Empire State College and a master’s
degree in health systems administration from the Rochester Institute of Technology
(RIT).
www.aapc.com
February 2012
37
Added Edge
By Steve Gray, AOES, COSS
Coders: Protect Your Most
Valuable Asset—You!
Don’t let repetitive stress syndrome affect your personal well-being:
Think ergonomics.
A
s an ergonomics specialist, I have worked with many coders
regarding workplace injuries. Over the past 20 years, I have
not seen another profession that requires more repetitive motion activities (e.g., continuous and repetitive keyboarding, mouse
clicking, and 10-key activities) than those required of professional
coders. As such, coders are at high risk for musculoskeletal ailments
such as carpal tunnel, back and neck injuries, etc.
The upcoming transition to ICD-10 means two additional keystrokes for every code entered (as five-digit ICD-9 codes become seven-digit ICD-10 codes), which will only increase the repetitive nature of the job. Now, more than ever, it is important to become aware
of how to protect yourself and stay injury-free.
Do you respond to your body’s signals before it’s too late? Take this
quiz and find out:
Take a Quiz
When I feel back discomfort, I change positions.
❏ yes
❏ no
When I feel back discomfort, I readjust my chair. ❏ yes
❏ no
When I feel back discomfort, I stretch.
❏ yes
❏ no
When I experience neck tightness or discomfort,
I check my monitor height and distance.
❏ yes
❏ no
When I have headaches, I check my monitor distance and display features.
❏ yes
❏ no
When I experience shoulder/arm discomfort, I
check to my workstation layout to make sure all
of my work tools are close by.
❏ yes
❏ no
If you answered “No” to any of these questions, it is time to pay attention to your body’s signals.
Ergonomic Essentials
Be Proactive: Listen to your body’s needs before you reach an alarming state. Your body will tip you off when there is something wrong
with your work environment by sending pain signals to and from
your brain. Do not disregard your body’s signals. Take proactive
measures to protect yourself by following simple ergonomic guidelines developed to keep you healthy and productive.
Create a Comfortable Workspace: Keep your work area clean and
clutter-free. Adequate workspace for your computer equipment and
38
AAPC Coding Edge
supplies is a must. Set up your workstation so that your most frequently used items are within your “comfort zone,” approximately a 20-inch radius. This will typically include your computer, keyboard, mouse, telephone, etc. Do not place items such as family photos and small mementos within your comfort zone area as you need
this space reserved for your primary keyboarding, 10-key and mouse
tasks, and reference books. Make sure you have space underneath the
desk to freely move your legs.
If it is within your company’s policy, personalize your workstation
with two or three small, “de-stress” personal items that are meaningful and bring a smile to your face. Stress causes your muscles to tense,
which can make you more prone to injury; the more stress you feel,
the lower your tolerance for pain.
If you work from home, have a designated desk and work area. Select
an area in your home that is free from distractions and outside noises.
Alternate Between Sitting and Standing: A medical coder typically spends 80-90 percent of the day sitting. We humans were not designed to sit to this extent, and it’s hard on our backs, legs, and knees.
Take short stretch breaks. Walk at lunch and during breaks. Relocate your printer or fax so that you have to walk to get to it. Practice
“dynamic sitting” by stretching and moving around in your chair. If
some of your tasks can be performed when standing, do so. Stretch
your lower back by standing up and pulling each knee to your chest,
holding that position for a few seconds.
Get a Good Chair: A properly fitted chair is one of the most vital
components for creating a safe and comfortable work environment.
Your chair seat should have the right depth and width for your size,
and be built to accommodate your general body structure. Adjust the
height of your chair so your feet rest flat on floor. It is even more important that your arms and shoulders be relaxed while keyboarding;
raise your chair high enough to relax the upper body and use a footrest for lower body support, if necessary. Do not work in a posture
with tensed or “shrugging” shoulders.
Lower back support should be provided by the lumbar area of the
chair back through adjustments to the chair back angle and height
adjustment. If you do not have lumbar adjustment on your chair, you
can roll up a towel and place it on the back of your chair for support.
Check Your Monitor Location: Is your computer monitor positioned so your body and/or neck aren’t twisted when viewing the
Added Edge
monitor? If you use dual monitors and they are used equally, set the
monitors next to each other (forming a slight V angle) at the same
height. If one monitor is used more than the other, position your
most frequently used monitor directly in front of you and place your
secondary monitor to the left or right.
Your eyes should be in line with a point on the screen approximately two or three inches below the top of the monitor. Sit back in your
chair (i.e., slight recline) and hold your right arm out horizontally, your middle finger should almost touch the center of the screen.
From that starting position you can then make minor changes to
screen height and angle to suit your preferences and comfort.
Note: If you wear bifocals or progressive lenses, you may want to lower the monitor slightly to counteract bending your neck upward to
view through the bottom bifocal part on your lens to avoid tilting
your head back or craning your neck forward.
In future articles, we will discuss keyboard and mouse “do’s and
don’ts,” including how to select and position a keyboard, how to
minimize clicking, etc.
istockphoto © Elvis Wilson
Steve Gray, AOES, COSS, of Innovative Ergonomic Solutions, Inc., has been
practicing the science and art of ergonomics for over 18 years. He is a member of
the management team at ERGOhealthy, an ergonomics services provider specializing in predicting and preventing work-related injuries and conducting remote-location and on-site ergonomic assessments to help people resolve issues with
their work processes and workstation environments.
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February 2012
39
Apprentice
Facility
By G. John Verhovshek, MA, CPC
Revisit the Rules with a Revised ABN
Get a signature or you may not get paid.
The Centers for Medicare & Medicaid Services (CMS) recently released a new Advanced Beneficiary Notice of Noncoverage (ABN).
If you are unsure of when or how to apply an ABN, now is the perfect
time to brush up on the details.
ABN Basics
The ABN is a standard form to inform a patient that Medicare may
deny coverage for a recommended or desired item or service. It explains why Medicare may deny the item or service, and provides a
cost estimate for it. Finally, an ABN notifies the patient of his responsibility to pay for the noncovered item or service, if he chooses to receive it. In many cases, a provider cannot seek payment from
the patient for unpaid Medicare services if an ABN was not properly issued.
CMS periodically revises the ABN. The most recent version, Form
CMS-R-131 (release date March 2011), is mandatory as of Jan. 1,
2012. Previous versions of the ABN (release date March 2008) are
no longer being accepted. The “Revised ABN CMS-R-131 Form and
Instructions” may be downloaded from the CMS website: http://www.
cms.gov/BNI/02_ABN.asp.
ABNs must be reproduced on a single page (either letter or legalsize). To be safe, reproduce the ABN “as is” from the CMS website:
Except where specifically allowed by the form instructions, “to integrate the ABN into other automated business processes,” you may
not customize the ABN.
Who Should Use an ABN
Per CMS instructions, ABN “notifiers” may include:
• Physicians
• Providers (including institutional providers, such as
outpatient hospitals)
• Practitioners
• Suppliers paid under Part B (including independent
laboratories)
• Hospice providers and religious non-medical health care
institutions (RNHCIs) paid exclusively under Medicare Part A
• Skilled nursing facilities (SNFs), for items or services expected
to be denied under Medicare Part B
The notifier must list her name in section A of the ABN form. The
physician, provider, etc., does not have to present the ABN to the patient personally; employees or subcontractors of the notifier may deliver the ABN.
When to Use an ABN
The ABN gives a Medicare beneficiary notice that Medicare “is not
likely to provide coverage in a specific case.” The patient’s name is
listed in section B of the ABN, and the item or service must be list-
If the patient refuses to sign, the
options are not to provide the
service or procedure (which might
raise potential negligence issues),
or to provide the service knowing
that the provider may not get paid.
iStockphoto©Sean Locke
40
AAPC Coding Edge
Facility
How NOT to Use an ABN
ABNs Aren’t Required in an Emergency
Do not use an ABN to bill a patient for additional fees beyond
what Medicare reimburses for a given procedure or service.
The ABN does not allow the provider to shift liability to the
beneficiary when Medicare payment for a particular procedure or service is bundled into payment for other covered
procedures or services. An ABN should never be applied as a
Band-Aid ® cure to gain payments in spite of sloppy coding, or
as a way to “game” Medicare beneficiaries.
ABNs are never required in emergency or urgent care situations. CMS
policy prohibits giving an ABN to a patient who is “under duress,”
including patients who need emergency department services before
stabilization.
ed in section D. Section C is an optional field to enter an identification number for the beneficiary to link the notice with a related
claim. Section C is not used to indicate the provider’s identification
number.
The provider must explain “in beneficiary friendly language” why he
or she believes Medicare may not cover the items or services (section
E). Common reasons a service may be denied include:
• Medicare does not pay for the procedure or service for the
patient’s condition.
• Medicare does not pay for the procedure or service as
frequently as proposed.
• Medicare does not pay for experimental procedures or
services.
The explanation of why Medicare may deny the item or service
should be as specific as possible. A simple statement of “Medicare
may not cover this procedure” is not sufficient.
Providers should list on the ABN each and every item or service that
might not be covered. Medicare relieves beneficiaries from financial
liability where they did not know and did not have reason to know
a service would not be covered. Without a valid ABN, the Medicare
beneficiary cannot be held responsible for denied charges.
Estimating Costs
The provider must provide a cost estimate for the proposed procedure or service (section F). CMS instructions stipulate, “Notifiers
must make a good faith effort to insert a reasonable estimate” and
“within $100 or 25 percent of the actual costs, whichever is greater.” CMS would allow an estimate to substantially exceed the actual costs because the beneficiary “would not be harmed if the actual
costs were less than predicted.”
CMS allows exceptions if the provider is unable to give a goodfaith estimate of costs, but these circumstances are expected to be
infrequent.
Complete the Form, Confer with the Patient
After ABN sections A-F have been completed, the Medicare beneficiary may choose to proceed with the procedure or service and assume financial responsibility, or may elect to forego the procedure or
service (section G). Under no circumstances can the notifier decide
this for the beneficiary. If the patient chooses to proceed, he may nevertheless request that the charge be submitted to Medicare for con-
sideration (with the understanding that it will probably be denied).
The ABN “must be verbally reviewed with the beneficiary or his/her
representative and any questions raised during that review must be
answered” before the patient signs and dates the ABN (sections I and
J). CMS requires that the provider present the ABN “far enough in
advance that the beneficiary or representative has time to consider
the options and make an informed choice.”
A copy of the completed, signed form must be given to the beneficiary or representative, and the provider must retain the original notice on file.
You Can Proceed Without a Signature, If Necessary
If the beneficiary refuses to sign an ABN, but still requests the procedure or service, the provider should document the patient’s refusal.
The provider and a witness should then sign the form. The patient’s
signature is not required for assigned claims (claims submitted by
and paid to a physician on behalf of the beneficiary).
To hold the patient financially liable, a signature is required on the
ABN for unassigned claims (claims submitted by the patient, who
then reimburses the physician). If the patient refuses to sign, the options are not to provide the service or procedure (which might raise
potential negligence issues), or to provide the service knowing that
the provider may not get paid.
Append Modifiers to Your Claim
When filing your claim, apply modifier GA Waiver of liability statement on file when the provider believes the service is not covered and
the office has a signed ABN on file.
Modifier GY Item or service statutorily excluded or does not meet the
definition of any Medicare benefit applies when Medicare excludes the
item or service from coverage. When you report modifier GY, Medicare will generate a denial notice that the beneficiary may use to seek
payment from secondary insurance, for instance.
If the provider fails to issue an ABN for a potentially uncovered service, append modifier GZ Item or service expected to be denied as not
reasonable and necessary to the claim. This indicates that the provider cannot hold the patient financially responsible if Medicare denies
the service, but will reduce the risk of fraud or abuse allegations for
claims deemed “not medically necessary.”
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.
www.aapc.com
February 2012
41
Added Edge
By Michelle A. Dick
Relieve Coding Stress: Help Your Ticker
Coders may code conditions and services
related to heart disease, but the nature of
coding and billing as a profession can also
make heart diseases a personal issue.
Since 1963, Congress has urged Americans
to join the battle against heart diseases and
required the president to proclaim February
as “American Heart Month.” The American Heart Association led initial awareness
efforts with the goal of teaching about heart
disease and stroke, and to raise money for
research and education.
Avoid the Factors Leading to Heart Disease
Being heart smart means that you:
❤❤ Monitor your cholesterol and
triglyceride levels, blood pressure,
waist size, and body mass index
(BMI). These major factors
determine heart health. Schedule a
checkup with your physician if you
don’t know these.
❤❤ Don’t smoke. Smoking causes
respiratory problems and lung cancer,
and it’s a major cause of heart disease.
❤❤ Exercise and eat healthy. These are
two most proactive things you can do
to maintain a healthy heart.
❤❤ Reduce stress. While some stress is a
normal part of life, excessive stress is
the cause of many ailments such as
insomnia, headaches, upset stomach,
and even coronary artery disease.
It’s nearly impossible to eliminate all life’s
stresses, but there are many ways you can reduce stress in your daily coding life.
Identify Stress that Coders Face Daily
Although not directly involved in the stresses of providing medical care, coders and
42
AAPC Coding Edge
billers
encounter
stress in other ways.
For example,
coding stress
can stem from not
meeting coded chart
quotas, physicians documenting incorrectly, vicarious trauma,
trying to keep up with payer guidance and coding changes, and not
having a good knowledge of medical
terminology and anatomy.
Medical billing stresses may involve having to explain charges, deal with criticism,
give and receive feedback, be assertive, manage databases, and communicate effectively
when a patient, insurance company, or client asks questions.
Procrastinating on preparing for inevitable
changes in our industry, such as ICD-10,
can also cause stress.
Reduce Coding-related Stress
Too much stress interferes with concentration and productivity and reduces physical
and emotional health, so it’s important to
find ways to keep it under control. There are
a variety of steps you can take to reduce both
overall stress levels and the stress you find in
the work environment. These include:
Find an Outlet to Relieve Your Stress.
For example, exercise, pray or meditate, or
read or write. These things work for Janet
L. Dunkerley, CPC, CPC-I, CMC, PCS,
senior consultant for QuadraMed. To promote overall well-being, she meditates and
practices yoga. She said, “I meditate daily
iStockphoto©Esperanza Gaffo
Improve, manage, or eliminate stress for a healthier heart.
and
don’t let minor things bother me. Keeping a positive attitude in a negative situation always seems
to work for me.” She continued, “It calms
me down and allows me to deal with unpleasant situations in a rational manner.”
Dunkerley realizes that she cannot always
change the situation around her, but she can
change how she deals with it. She said, “I
also practice yoga. I find that if I take care of
my mind and my body, everything else just
seems to fall into place.”
Identify and Change Negative Attitudes that Add to Work Stress.
For Susan Edwards, CPC, dealing with
unprofessional attitudes is one of her biggest stresses while coding outpatient facility/physician claims at a critical access hospital in rural Vermont. She admits, “The
most frustrating and stressful part of my
job is dealing with unprofessional people.”
She said the best way for her to handle and
overcome this stress is “to get a cup of coffee, take deep breaths, and try to focus on
Added Edge
13 Tips for Managing
Coding and Billing Stress
Lorraine J. Sivak, CPC, is a billing/office
manager for Joseph J. Sivak, MD and Troy D.
Otterson, MSW, LICSW. As the medical office
administrator, she is responsible for all functions of the small medical practice, including
billing and coding. Outside of direct patient
care, she said, “My most stressful part of
the job is education and keeping current with
insurance company rules and regulations, the
ever-changing federal guidelines, and EHR
and electronic prescription (eRx) guidelines.
Managing all of this information and deciding
what is most relevant to each provider, is time
consuming and most times overwhelming.”
Sivak said, “I have not found a way to eliminate
the stress associated with having to ‘know’ and
keep up with all the changes.” Because she
can’t eliminate the stress, she has created tips
to help manage her stress-related demands:
1. Network with other office administrators
from other facilities in the community.
2. Network with AAPC coders and billers.
3. Network with other facilities in the same
specialty.
4. Take the time to read through insurance
company updates and alerts.
5. Subscribe to the Centers for Medicare &
Medicaid Services (CMS) newsletters.
6. Use Medicare Learning Network and navigation for insurance information portals.
7. Stay ahead of changes and plan for the
implementation of those changes.
8. Keep open and honest communication with
all employees and keep them informed of
issues as a team.
9. Realize that no “one” employee should be
kept out of the loop.
10.Make a reference notebook on issues that
have been solved and how to solve it for
future use.
11.Organize necessary information, weed out
irrelevant information, and have a system
to access it.
12.Don’t be afraid of change.
13.Rest, relax, walk, and take care of yourself,
so you can do it all again tomorrow.
Although Sivak has not overcome coding and
billing stress, she recognizes it’s there and
manages it. Sivak said, “I am a list person, so
every week I sit with my calendar and figure
out what has to be accomplished for each
week.” She said, “Using the list and planning,
as best I can, is my lifesaver.”
another area of work until I can approach
the stressful situation in a clear, level-headed
way.” Strengthening communication skills
to ease and improve relationships with management, coworkers, and patients also help
to reduce attitude-related stress at work.
Use Task Management to Prioritize Your Workload.
Do tasks in the order of importance. Analyze your schedule, responsibilities, and daily tasks. If any task is unpleasant to do, get
it done early in the day. Once the daunting
task is done, the remainder of the day will
be easier. Break projects into small steps. If
a large project seems overwhelming, make
a step-by-step plan. Focus on one manageable step at a time, rather than taking on everything at once.
When it comes to managing work tasks,
know how much work you can handle and
try not to over-commit yourself or you’ll set
yourself up for failure. If you do take on too
much work, delegate some of the responsibility. Unite with co-workers. Help coworkers when they need help and others
will assist you in times of stress. Just knowing that someone’s got your back will reduce
your stress level.
Arlene J. Kelley, CPC, is a medical coder for a multi-specialty group in Duluth,
Minn. who has a heavy workload. She says
there are “not enough hours in the day to get
the work done.” To manage her overabundance of work, she said, “I pace and organize
myself. I deal with it—first in, first out.” She
admits, “I really don’t overcome it, but vacation helps.”
Don’t let your heavy workload carry into
your home life. All work and no play is a
recipe for burnout. Find a balance between
work and family life, social activities and
daily responsibilities, and downtime.
Find Humor and Reasons to Think Positive.
Think positive. Negative thinking drains
your energy and motivation. Find humor
in work and life’s unpleasant and stressful situations. When you, or your co-workers, start taking things too seriously, break
through the tension with laughter. Share a
joke or funny story. Humor works for Shreka Rogers, CPC, CMRS, CMSCS. She
uses laughter to cope with stress because
“Most of the time eliminating stress is not
an option.” Rogers said, “I keep a sense of
humor by finding fun ways to help me and
my staff learn. For instance, we played coding Jeopardy to learn the 2012 procedure
code updates.” She added, “The staff had a
great time and they were able to learn and
retain the information.”
If humor doesn’t work on a co-worker with
Eeyore’s attitude, stay positive and only engage with them when necessary for completing job tasks. You don’t want their unpleasant, bad attitude affecting your positive demeanor.
When Stress Takes Over, Switch Gears.
Take a mental break from the stress. Leave
the stressful situation, project, or coding assignment and come back with a clear head.
Plan short breaks or complete a short, less
daunting task first. Rena Hall, CPC, who
works in billing/collections at KC Neurosurgery Group, LLC., uses this de-stress
technique “when dealing with the monetary elements for the office (coding, billing,
insurance follow up, and collections).” She
finds keeping the accounts receivable “tidy”
as being particularly stressful. Hall said,
“Some patients tend to be less than pleasant
when we ask them for payment while collecting for the services provided.” She continued, “To deal with this stress, I am fortunate to work in an office that allows me to
vary my duties on a daily basis. If I feel overwhelmed, I can set the job aside and work
on something else for a while.” She added,
“There is always a lot to do at my desk!”
Remain Calm
Managers can be the key to helping keep
stress levels in the workplace to a minimum.
Good managers act as positive role models,
especially in times of high stress. All of the
tips mentioned in this article are twice as
important for managers to follow. If someone you admire remains calm, it is much
easier to remain calm yourself.
If none of these de-stressing techniques
work, remember that trained, professional medical billers and coders are in high demand. It’s your health at risk. When work
is unmanageable, don’t be afraid to look
around for a less stressful position.
Michelle A. Dick is executive editor at AAPC.
www.aapc.com
February 2012
43
Coder’s Voice
By Geanetta Johnson Agbona, CPC, CPC-I, CBCS
Teach Medical Terminology,
the Fun Way
Use the five senses to help
students learn and retain difficult medical words.
Medical terminology is challenging. It’s laced with long and playful words such
as gastrojejunostomy, hysterosalpingostomy, and esophagogastroduodenoscopy.
How can instructors teach such difficult medical terminology in a creative, effective way? Don’t let it become an arduous undertaking; make it fun by engaging
all of your students’ senses: taste, touch, smell, sight, and hearing.
Engage the Sense of Taste
When teaching medical terms related to the digestive system, taste buds come
in handy. The digestive system begins with the oral cavity: lips, palates, tongue,
gums, and teeth. Using foods that are sweet, sour, spicy, and salty is a great way
to introduce the oral cavity and explain the process of mastication (chewing) and
deglutition (swallowing). It tastes good, too!
Caution: Some students may have food allergies, so choose your food samples carefully.
Student constructs heart from play dough.
Engage the Sense of Touch
Recently, a group of my students were given several cups of play dough. Using a
chart found in The Language of Medicine (ninth edition), each student constructed his or her own version of the heart. The students then explained the blood flow
and structure of the heart. This also enabled them to code more confidently from
the CPT® codebook.
The students were also asked to use the play dough to construct the urinary system. The feedback from the students was positive. “I just know the body parts
and terminology when I build the body system with play dough,” one student
said. Another student added, “I don’t memorize anything, I learn it.”
Engage the Sense of Smell
Choose objects that are enjoyable or soothing to smell: Febreze®, cinnamon,
or chocolate, for instance. Use this opportunity to explain respiration to your
students.
Caution: Students who have allergies may not be able to participate and should be forewarned.
Engage the Sense of Sight
Teaching students medical terminology also involves a discussion of various procedures. For example, beginners may struggle to code Mohs surgery. Using a video clip of an actual Mohs surgery is an effective way to explain the various stages
and frozen sections performed during this procedure.
Continued on page 48
44
AAPC Coding Edge
Play dough urinary system helps teach.
newly credentialed members
A’vis L Brown, CPC
Aarthi Thanigairasu, CPC
Adi Gazit, CPC
Adianet Rivero, CPC
Akila Ramasamy, CPC
Alagu Parameswari Pitchiah, CPC
Alice L Monahan, CPC
Alice Ramos, CPC
Alnita Yvette Brown, CPC
Amanda Hubbard, CPC
Amber Soucy, CPC
Amber Walters, CPC
Ammy Lamoreaux, CPC
Amy Bridges, CPC
Amy Creed, CPC
Amy DeGolier, CPC
Amy Jo Pelster, CPC
Amy Melissa Dillard, CPC
Amy Tang, CPC
Analyn Y Mingaracal, CPC
Andre Shepherd, CPC
Andrea Johnson, CPC
Andrea R Richey, CPC
Angela Ann Kelly, CPC
Angela Luffman, CPC
Angela Renee Stevenson, CPC-H
Anita Torrance, CPC
Anjanette Heflin, CPC
Anjanette Heflin, CPC
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April Massimino, CPC, CGIC
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April Tranece Reed-Williams, CPC
Ariady Suarez, CPC, CPC-H
Ariana Amidi, CPC
Ariel Bumpass, CPC
Arnissa Burns, CPC
Ashley B Martin, CPC
Ashley Wallace, CPC
Ashlyn Smith, CPC
Awilda Bonilla, CPC
Barbara Baker, CPC
Barbara Holbrook, CPC
Barbara J Oakley, CPC, CPC-H
Beatrice Lynn McCoy, CPC
Belinda B Way, CPC
Beth Snyder, CPC
Blanca Rodriguez, CPC
Brandy DeAnn Sherrer, CPC
Brandy Walker, CPC
Brenda Love, CPC
Brenna McCartt, CPC
Brittany Marie Hatch, CPC
Carol A Lee, CPC-H
Carol Jaco, CPC
Carol Wigant, CPC, CPC-H
Carolee Maresco, CPC
Carolyn Cleveland, CPC
Catherine Ann Digard, CPC
Catherine Dixon, CPC
Cathy Billett, CPC
Cathy Cox, CPC-H
Cathy L. Smith, CPC
Catie Ryczek, CPC
Charles Krimm, CPC
Charlie LeCroy Averette, CPC
Chasity Dotson, CPC
Chelsea Tiera Jones, CPC
Cheryl A Porter, CPC, CPC-P
Cheryl Langelier, CPC
Chitra Balu, CPC
Christeni L Oregon, CPC
Christina L Belasco, CPC
Christine LaBarbera, CPC
Christine Thompson, CPC
Christopher Duke, CPC
Chrystal Michelle Little, CPC
Claudette Jones Price, CPC
Colleen O’Hara Warren, CPC
Connie Burtsell, CPC
Connie Cammilleri, CPC
Connie Werts, CPC
Constance Musachio, CPC
Consuelo Garcia Saenz, CPC
Coriander Pulliam, CPC
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Cory Wedding, CPC
Crystal Crain, CPC
Cynthia Ferrer, CPC, CPC-H
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Dagmar A Nelson, CPC
Daisy Frontela, CPC
Dana Holston, CPC
Danielle Marie Nicholson, CPC
Darah Nelson, CPC
Darla Hammons, CPC
Darla Faulk, CPC
Dawn Andino, CPC
Dawn M Givens, CPC
Deanna L Beck, CPC, CPC-H
Debbie LeBar, CPC
Debbie Lynn, CPC
Debbie M Traber, CPC
Debbie McElveen, CPC
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Debi Noonan, CPC
Deborah Brock, CPC
Debra K Hiett, CPC
Decia B Moore, CPC
Dee D Payne, CPC
Delynn Merrick, CPC
Denise Ballou, CPC
Denise Lynn Moore, CPC
Denise Rex, CPC
Detress Whisenton, CPC
Diane Peterson, CPC
Donna Cline, CPC
Donna Hager, CPC
Donna Rice, CPC
Dora Creasy, CPC
Doreen Hanlon, CPC
Doris R Alicea, CPC
Elisa F McMillan, CPC
Elizabeth Bailey, CPC
Elizabeth Copley, CPC
Elizabeth Lipscomb Heintz, CPC
Ella Kalpana, CPC
Ellen Hartsfield, CPC
Emma Betancourt, CPC
Erica Dudenhoeffer, CPC
Erica Marcela Celedon, CPC
Erika L Darrah, CPC
Erina Murcia, CPC
Evelin Piedra, CPC
Felicia Varela, CPC
Francisca Preciado, CPC
Gail Moyer, CPC
Gail Pippi, CPC
Gina Emburey, CPC
Giovanna Maria Sabat, CPC
Gladys Tania Haston, CPC
Glenda Butler, CPC
Gloria Davis, CPC
Griselda Mendoza, CPC
Gwendolyn D Clark, CPC
Gwendolyn Wilson, CPC
Hauns Martin, CPC
Hayley Marie Piper, CPC
Hazel Ochabillo, CPC
Heather Graddy, CPC
Heather Swett, CPC
Hermenegildo Morejon, CPC
Hilda T Shurbaji, CPC
Holly Cogswell, CPC
Holly Krogman, CPC
Holly Morris Keplinger, CPC
Holly Tinelli, CPC
Hope A Prendergast, CPC
Ilona Acree, CPC, CPC-H
Ivy Marie Carter, CPC
Jacqueline Oranski, CPC
Jamel Nikkia McKnight, CPC
Jamie Smith, CPC, CPC-H, CEDC
Jamie Smithson, CPC
Janeece Elena Flournoy, CPC
Jean C. Bayer, CPC
Jean Justus, CPC
Jennifer Kay Warman, CPC
Jennifer L Robbins, CPC
Jennifer L West, CPC
Jennifer Lea St Pierre, CPC
Jennifer Lynn Wolf, CPC
Jennifer Olah Galloway, CPC
Jennifer Stevens, CPC
Jennifer Trotta, CPC
Jerry Lee Kelley, CPC
Jessica Carlin, CPC
Jessica Peloquin, CPC
Jessica Suzann Ottinger, CPC
Jessica Velten, CPC
Jill Anne Ahrens, CPC
Jill Johnson, CPC
Jill Stafford, CPC
Jodi Hardy, CPC
Jody Harrison, CPC, CPC-H
Joelle Lutgen, CPC, CPC-H
Joseph Andrew Goldstein, CPC
Joyce Figueroa, CPC
Joyce Travis, CPC
Judy Burns, CPC
Judy Gibson, CPC
Julie C Bates, CPC
Julie Stephens, CPC
Julieanna Louise Pali, CPC
Kaja Duty, CPC
Kalaiyarasan Rajendiran, CPC
Karen Kodramaz, CPC
Karen Martin, CPC
Karen Plumb, CPC
Karen Warner, CPC
Kari Marie Smith, CPC
Katherine A Goodridge, CPC
Katherine Lee, CPC
Kathleen M Kenealy, CPC
Kathleen M Kopac, CPC
Kathy Curry Grim, CPC
Kathy Godwin Oakley, CPC
Kathy L White, CPC, CPC-H
Kathy S Burke, CPC
Katrina L Rasmussen-Carey, CPC
Kattakuri Sunitha, CPC
Kauser Sandila, CPC
Kay G Allen, CPC
Keesha L Coram, CPC
Kelly Brooks, CPC
Kelly Dolasco, CPC
Kelly Jordan, CPC
Kenia Molles, CPC
Kerri Smith, CPC
Kerry Hogan, CPC
Kerry Susan Ritchie, CPC
Kettisha Barnes, CPC
Khaleel Syed, CPC
Kim Brandt, CPC
Kim Catlett, CPC
Kim Dianne Stults, CPC
Kimberly Lichtenfels, CPC
Kimberly E Simpson, CPC, CPC-H
Kimberly Faye Tipton, CPC
Kimberly Frey, CPC-P
Kimberly Hargrove, CPC
Kimberly R Cowan, CPC
Kimberly Suarez, CPC
Kimberly Suarez, CPC
Kirsten E Treantafillou, CPC
Kitleyann West, CPC
Kizzy Warfield, CPC
Kris A Morgan, CPC
Kristen Thompson, CPC
Kristin E Davis, CPC
Kurt Alyn Kaskie, CPC
Kyle Nichole Mallett, CPC
Lakesha N Davis, CPC
Lasa Moseman, CPC
Lashunda Murray, CPC
Lashunia Tashiela Lascorpia Frazier, CPC
Lauren Motta, CPC
Laurie Daigle, CPC
Laurie Floyd, CPC
Leah Beerly, CPC
LeAnn L Caldwell, CPC
Leanna Hammond, CPC
LeAnne Bombard, CPC
Leanne Collins, CPC-H
Lesa Titus, CPC
Leslie E Blystone, CPC
Leta Kay Likes, CPC
Libby Vallee, CPC
Lila M Cummings, CPC
Linda D Brockman, CPC
Linda Dickerson, CPC
Linda Hoffman, CPC
Linda Laghab, CPC
Lisa Armstrong, CPC, CPC-H
Lisa Etherton, CPC
Lisa L Pitzer, CPC
Logesh Kumar, CPC
Lorena Reyes, CPC, CPC-P, CHONC
Lori Colleen Raub-Walls, CPC
Lori Robinson, CPC
Lori Walker, CPC
Lorraine LeDonne, CPC
Louise Brockman-Wright, CPC
Lynne McCannon, CPC
Lynne Reph, CPC
Mabel Hall, CPC
Madhavi Ghadigaonkar, CPC
Mae Marfil-Verdadero, CPC
Mara Mendez, CPC
Marc A Quick, CPC
Marcella Coddington, CPC
Margaret Altimare, CPC
Margaret D Bichsel, CPC
Margaret Leland, CPC
Margaret Marie Vasquez, CPC
Margaret Marie Vasquez, CPC
Margarette Ann Neary, CPC, CPC-H
Margarita Melendez, CPC
Margot Smith, CPC
Maria E Plata-Lopez, CPC
Marianne McCafferty, CPC
Marianne Swilley, CPC
Marilyn Carpenter, CPC
Marina Ruiz, CPC
Marion M Banks, CPC
Marisa Golliet, CPC
Marlene Smith, CPC
Mary A Pansulla, CPC, CPC-H
Mary Butler, CPC
Mary F Heffernan, CPC
Mary M Taylor, CPC
Mary R Moore, CPC, CPC-H
Maryulys Toledo, CPC
Maureen Roberts, CPC
Maureen Williams, CPC-P
Megan Ailey, CPC
Megan Polkus, CPC
Melanie Sayer, CPC
Melanie Torbert, CPC
Melinda Martin-Payton, CPC
Melinda S Menke, CPC
Melissa A Stogsdill, CPC
Melissa DeLoach, CPC
Melissa Fretz, CPC
Melissa Le Snyder, CPC
Melissa Marie McDonald, CPC
Melissa Sanders Goodwin, CPC
Melissa Updegrove, CPC
Mercedes Sandoval, CPC
Meredith Anne Ruark Davidheiser, CPC
Meredith M Mauldin, CPC
Michael Patrick Kerwin, CPC, CPC-H
Michael S Resan, CPC, CPC-P
Michaela Frances Maher, CPC
Michele Fernandez, CPC
Michelle Anderson, CPC
Michelle Camerlin, CPC
Michelle Cecile Defaria, CPC
Michelle Constandis, CPC
Michelle E. Papke, CPC
Michelle Weaver, CPC
Mihaela Tamblyn, CPC
Misty Puterbaugh, CPC
Mitzi Hobson Cooper, CPC
Monica Faye Rayburn, CPC
Monika Marie Carley, CPC
www.aapc.com
Murali Krishnan Nammalwar, CPC
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Nampi Poomalai, CPC
Natosha Bland, CPC
Nereida Zaragosa, CPC
Nicole C Riedel, CPC
Nicole Marie Madon, CPC
Nicole Smith, CPC-P
Noy Birger, CPC
Oby C Egbunike, CPC, CPC-H, CCS-P
Olga Torres, CPC
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Pamela Klopfenstein, CPC
Pat Mankin, CPC-H
Patricia Lynn Dykes, CPC
Paula Melvin, CPC
Pauline Epie Etta, CPC
Phillis Marler, CPC, CIMC
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Pradeepa Elumalai, CPC
Rachelle Aubrey, CPC
Rajeswari Veereswaran, CPC
Ramona W Burrows, CPC
Ravi Natarajan, CPC
Rebecca A Miller, CPC
Rebecca Murphy, CPC
Rebecca Ramirez-Perez, CPC
Rebecca Schmidt, CPC
Renada Nicholas, CPC
Renee Brown, CPC
Rhonda Flanagan, CPC, CPC-H
Rhonda R Bowerman, CPC
Richard Alan Powell, CPC
Rivka Portnoy, CPC-H
Robert Charette, CPC
Robin Collopy, CPC-H
Robin King, CPC
Robin Plocharczyk, CPC
Robin Stapleton, CPC
Rosemary Plourde, CPC
Roxanne E Lollar, CPC
Safeeque Ahmed, CPC
Samantha Caplan, CPC
Sandra A Schneider, CPC
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Sarah Flanagan, CPC
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Sathesh Devaraj, CPC
Seta Donigian, CPC
Shannon Bobbi Houston, CPC
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Shannon Quay, CPC
Sharese S Numan, CPC
Shari A LaStrape, CPC
Sharon Elgin, CPC
Shawna Farnsworth, CPC
Shelia McDougles, CPC
Shelley Perron, CPC, CPC-H
Sherie Martin, CPC
Sherrie Neidigh, CPC
Sherry Snyder, CPC
Sheryl Jackson, CPC
Shweta Verma, CPC
Shyr Roble, CPC
Sioban Ryan, CPC
Sreelal Vijayan Sreelatha, CPC
Stacey Lynne Hitchcock, CPC
Staci Elene Kreiser, CPC
Stephani Rhea Tyler, CPC
Stephanie Driver Robertson, CPC
Stephanie Higbee, CPC
Stephanie Marie Ferguson, CPC
Stephanie VanderPloeg, CPC
Suganthi Ramu, CPC
Susan Bastian Stallone, CPC
Susan Dawn Sumpter, CPC
Susan E Pollan, CPC
Susan Gamble Ladd, CPC
Susan J Ellis, CPC
Susan LaForge, CPC
Susan LeBegue, CPC-H
Susan Schick, CPC
Susan Whiteis, CPC
February 2012
45
Newly Credentialed Members
Suzzette Marie Giordano, CPC
Tabbitha Prentice, CPC
Tamara Blaydes, CPC
Tameka M Williams, CPC
Tamie Hollis, CPC
Tamika Gibbs, CPC-H
Tanika Jennings, CPC
Tara Elizabeth Diffley, CPC
Teela Monique Mayo, CPC
Tennille Fry, CPC
Teresa A Wik, CPC
Teresa M Godinez, CPC
Teresa Thornhill, CPC
Terri A Dinger, CPC
Terri Shea Dabbs, CPC
Terry J Blitchok, CPC
Therese Biroscak, CPC
Tifany Mulumba, CPC
Tiffaney Reynolds, CPC
Tina Hassell, CPC
Tina L. Mcdaniel, CPC
Tish Hermann, CPC
Tonya Mills, CPC
Tovey Summers Maldonado, CPC
Tracy Chase, CPC
Trisha Jacobson, CPC
Udhayakumar Subramani, CPC
Valerie L. Sullivan, CPC
Vanessa Margaret Kissinger, CPC
Veera Sudheer Babu Ananta, CPC
Vicki Battioli, CPC
Vickie Branson, CPC
Vickie Kimball, CPC
Vickie Tremmier, CP
Vilma Alvarez-Marin, CPC
Viola Miller, CPC
Wendy Cave, CPC
William Mortensen, CPC, CPC-H
Yolanda N Lopez, CPC
Zandra Young, CPC
Zoe Taylor, CPC
Apprentices
Aaren Myers, CPC-A
Abigail McKibbon, CPC-A
Adam Shoop, CPC-A
Adam Turner, CPC-A
Addie Gibbs, CPC-A
Adriana Carrillo, CPC-A
Afke Dalfonso, CPC-A
Alesia Danielle Hollis, CPC-A
Alesia Sprouse, CPC-A
Alexandra Jimenez, CPC-A
Alexandra Kingsley, CPC-A
Alexis Conyers Clark, CPC-A
Alicia Bruno, CPC-A
Alicia Crump, CPC-A
Alicia Green, CPC-A
Alicia Hooper, CPC-A
Alicia Ogaffney, CPC-A
Alison Bennett, CPC-A
Alison Guido, CPC-A
Alma Dela Cruz, CPC-A
Alyssa Bryant, CPC-A
Amanda D Tate, CPC-A
Amanda DiVittore, CPC-A
Amanda Gress, CPC-A
Amanda Grimstead, CPC-A
Amanda Hubbard, CPC-A
Amanda Westfall, CPC-A
Amanda Workman, CPC-A
Amber Swaffer, CPC-A
Amber Eckert, CPC-A
Amber L Grindstaff, CPC-A
Amber Lynn Bingaman, CPC-A
Amber M Sheffield, CPC-A
Amber Warner, CPC-A
Amberly Nicole Davis, CPC-A
Amparo O Lopez, CPC-A
Amrita Banerjee, CPC-A
Amy B Carlson, CPC-A
Amy Gibson, CPC-A
Amy Haley, CPC-A
Amy Haugh, CPC-A
Amy Hughes, CPC-A
Amy Jo Meyer, CPC-A
Amy Maxfield, CPC-A
Amy Piper, CPC-A
Amy Rhodes, CPC-A
46
AAPC Coding Edge
Anantharaman Panneerselvam, CPC-A
Andrea Neske, CPC-A
Andrea Nicole Johnson, CPC-A
Andrel Jones, CPC-A
Andrew Wade Graves, CPC-A
Andrew E. Soto, CPC-A
Andrews Arokiyaraj, CPC-A
Angela Gayle Brooks, CPC-A
Angela Ivester, CPC-A
Angela Lim, CPC-A
Angela Miller, CPC-A
Angela Pickens, CPC-A
Anita Escobales, CPC-A
Anita Ray, CPC-A
Anna Kondracka, CPC-A
Annalakshmi Arumugham, CPC-A
Annamarie Vutuc, CPC-A
Annammal Merly, CPC-A
Anne Marie Jetmore, CPC-A
Anne Marvel, CPC-A
Antonietta Marshall, CPC-A
April L Gerni, CPC-A
Ariel Dimanche, CPC-A
Arivu Paramasivam, CPC-A
Arunkumar Thangaperumal, CPC-A
Ashley Davis, CPC-A
Ashley Felder, CPC-A
Ashley Lowry, CPC-A
Ashly M Wilcox, CPC-A
Audrey Shaver, CPC-A
Azad Singh, CPC-A
Balaji Marisamy, CPC-A
Barbara Bracy, CPC-A
Barbara OBrien, CPC-A
Barbara Cronin, CPC-A
Barbara Duncan, CPC-A
Barbara Freeman, CPC-A
Barbara L Buman, CPC-A
Barbara Lagudi, CPC-A
Barbara Lynn Parks, CPC-A
Beatrice Bright, CPC-A
Becky Lillian Smith, CPC-A
Becky Turner, CPC-A
Berneice Schroeder, CPC-A
Bert I Simmons, CPC-A
Besma Sagman, CPC-A
Beth Semasky, CPC-A
Beth A Kellogg, CPC-A
Beth Ann Finneran, CPC-A
Beth Kusch, CPC-A
Beth Messinger, CPC-A
Bethaney Cayer, CPC-A
Bethany Hope Coyne, CPC-A
Bethany Sanders, CPC-A
Betty A Jacobs, CPC-A
Bev Kohlrusch, CPC-A
Beverly Jane Skelton, CPC-A
Billie McGinnis, CPC-A
Binitha Mathew, CPC-A
Blanca Barroso, CPC-A
Bobbie G Louis, CPC-A
Bonita Thomas, CPC-A
Bradley Green, CPC-A
Brandilyn Graham, CPC-A
Brandy Highsmith, CPC-A
Brandy Schutt, CPC-A
Brenda Estes, CPC-A
Brenda Carol Carr, CPC-A
Brenda Rae Lee, CPC-A
Brenna Hackler, CPC-A
Brian Muffie, CPC-A
Bridget Reed, CPC-A
Brieana Dugas, CPC-A
Brittaney Allura Lee Hall, CPC-A
Brittany Bertacini, CPC-A
Brittany Jade Leveque, CPC-A
Brittney Hawkins, CPC-A
Brittni Naugle, CPC-A
Brooke Ashley Dupre, CPC-A
Bruce Beltz, CPC-A
Bruce Brunson, CPC-A
C. Pamela Danforth, CPC-A
Caitlen Irene O’Riley, CPC-A
Calvenia P Dozier, CPC-A
Camilla Hoffsommer, CPC-A
Carletta Ellen Vasknetz, CPC-A
Carlye Creech, CPC-A
Carmen Harms, CPC-A
Carmen S Valdez, CPC-A
Carol Seidenburg, CPC-A
Carolina Alba Bejarano, CPC-A
Caroline M Burdeshaw, CPC-A
Carolyn Ede, CPC-A
Carolyn McLaughlin, CPC-A
Carrie Riggle, CPC-A
Casey Barton, CPC-A
Cassandra LaCour, CPC-A
Catherine A Oleszek, CPC-A
Catherine Chance, CPC-A
Catherine Petrillo, CPC-A
Catherine Simerly, CPC-A
Celina Marie Gottlieb, CPC-A
Chana’ Lee, CPC-A
Charlene Hill, CPC-A
Charles Prathap, CPC-A
Chelsea Mays, CPC-A
Cheryl Cali, CPC-H-A
Cheryl Richards, CPC-A
Cheryl Smith, CPC-A
Chittibabu A, CPC-A
Christi Walker, CPC-A
Christina Gibson, CPC-A
Christina Girard, CPC-A
Christina M Rhude, CPC-A
Christina Marie Walton, CPC-A
Christina Mosley, CPC-A
Christina Nash, CPC-A
Christine Spurgis, CPC-A
Christine Davis, CPC-A
Christine Hurley, CPC-A
Christine M Leitzke, CPC-A
Christine Morin, CPC-A
Christopher Waters, CPC-A
Chyril Minnick, CPC-A
Cindy Ann Golphin, CPC-A
Cindy Marie Michalak, CPC-A
Claretta Joseph, CPC-A
Claudette Marie Tevis, CPC-A
Cliff Perkins, CPC-A
Colene Dennette McHale, CPC-A
Colleen Seipel, CPC-A
Corina Vierra, CPC-A
Courtney Gentes, CPC-A
Courtney Elizabeth Walker, CPC-A
Courtney Erin Birnbaum, CPC-A
Cristi McDonald, CPC-A
Cristina Alvarez, CPC-H-A
Crystal Poetker, CPC-A
Crystal Wittensoldner, CPC-A
Cynthia Waddock, CPC-A
Cynthia A Edgar, CPC-A
Cynthia Diane Douthat, CPC-A
Cynthia Eubanks-Smith, CPC-A
Cynthia Gest Arneson, CPC-A
Cynthia Lipsey, CPC-A
Cynthia Metcalf, CPC-A
Cynthia Sakshaug, CPC-A
Cynthia Smith, CPC-A
Daisy Carrillo, CPC-A
Dalia O’Donnell, CPC-A
Dana C Hasty, CPC-A
Dana L Valla, CPC-A
Dana Schaich, CPC-A
Danielle Frisbie, CPC-A
Danielle L Preister, CPC-A
Danielle Miller, CPC-A
Danielle Stary, CPC-A
Darcey Miller, CPC-A
Darlene Carr-McDaniel, CPC-A
David Garbush, CPC-A
David Martin Christian, CPC-A
Dawn Blanchard, CPC-A
Dawn Kindley, CPC-A
Dawn M Reed, CPC-A
Dawna Pedersen, CPC-A
Deana K Beall, CPC-A
Deanna Stevens, CPC-H-A
Deb Fross, CPC-A
Deb Norris, CPC-A
Debbie Romero, CPC-A
Debby Carol Botticelli, CPC-A
Debi S Behunin, CPC-A
Deborah Hill, CPC-A
Deborah Jones, CPC-A
Deborah L Long, CPC-A
Deborah Napper, CPC-H-A
Deborah Wilson, CPC-A
Deborah Yohannan, CPC-A
Debra J Garcia, CPC-A
Debra Peay, CPC-A
Debra R Volcko, CPC-A
Debra Wheadon, CPC-A
Debra Young, CPC-A
December Noble, CPC-A
Dee Welch, CPC-A
Deepa Ganapathi, CPC-A
Deidre Nealon, CPC-A
Deidre Velazquez, CPC-A
Delana Sonnier, CPC-A
Delphina Ann Dokey, CPC-A
Dena Lee, CPC-A
Denine Polito, CPC-A
Denise Claire Glenn, CPC-A
Denise Neveu, CPC-A
Denise Rivard, CPC-A
Denise Spargo, CPC-A
Dennis Ray Lamb, CPC-A
Dhanya Joseph, CPC-A
Diana Vick, CPC-A
Diana Kondracka, CPC-A
Diana Melusky Brewer, CPC-A
Diana Vincent, CPC-A
Diane Hower, CPC-A
Diane Baeten, CPC-A
Diane Brown, CPC-A
Diane Griego, CPC-A
Diane Pridgen, CPC-A
Diane Tyrrell, CPC-A
Diane Walker, CPC-A
Dianne Dolan, CPC-H-A
Dona R Placzkowski, CPC-A
Donna J Monson, CPC-A
Donna J Monson, CPC-A
Donna Marie Wilcox, CPC-A
Donna Marie Wright, CPC-A
Doreida Diaz, CPC-A
Dori Gilman, CPC-A
Doris Zeleznok, CPC-A
Dorothy Estrada, CPC-A
Dru LaMay, CPC-A
Dulce Lujan, CPC-A
Dulce Moldez, CPC-A
Eddria Gillespie, CPC-A
Edith A Kerrigan, CPC-A
Edward Chavoso Bautista, CPC-A
Eileen M Fischer, CPC-A
Eileen V. Fallon, CPC-A
Elaine Marie Wyatt, CPC-A
Elena Y W Mok, CPC-A
Elesa Beale-Marlowe, CPC-P-A
Elizabeth Bradley, CPC-A
Elizabeth Clarke Britt, CPC-A
Elizabeth Dorner, CPC-A
Elizabeth Kloss, CPC-A
Elizabeth Pulice, CPC-A
Elizabeth S Rodriquez, CPC-A
Elizabeth Zook, CPC-A
Ellen Bower, CPC-A
Elly Hjelt, CPC-H-A
Emmanuel Marcelo, CPC-A
Ephraim Dela Cruz, CPC-A
Erica Bolster, CPC-A
Erica Cumberlander, CPC-A
Erica DiBitetetto, CPC-A
Erica L Mage, CPC-A
Erica Rose Ellis, CPC-A
Erica Wildinger, CPC-A
Erika Anne Sieg, CPC-A
Erin Keyes, CPC-A
Errol Villanueva Azuela, CPC-A
Esther Whittemore, CPC-A
Ethel McKenna, CPC-A
Eva Ellen Kinyon, CPC-A
Fallon Greyslak, CPC-A
Fasiya Ahamed, CPC-A
FaTima Waterson, CPC-A
Felicia A Hartman, CPC-A
Franca Ancell, CPC-A
Gabrielle Summerlin, CPC-A
Gail Browning, CPC-A
Gail Fowler, CPC-A
Gary W Needham, CPC-A
Gaye Muslimani, CPC-A
Genice Longo, CPC-A
Geraldin Robles, CPC-A
Gina Lynette Louis, CPC-A
Gina Ownby, CPC-A
Gina Spiaggia, CPC-A
Glenn Allen McClendon, CPC-A
Glenn Brett Wilson, CPC-A
Gloria Ann Flowers, CPC-A
Gloria J Donohue, CPC-A
Gloria Moulton, CPC-A
Gloria Watts, CPC-A
Gunaseelan Alagarsamy, CPC-A
Gwen McClendon, CPC-A
Gwin Merriman, CPC-A
Hallie Brooke Mello, CPC-A
Harold (Buddy) Lee Idol, CPC-A
Harriet Tsikalakis, CPC-A
Heather Bryans, CPC-A
Heather Corson, CPC-A
Heather E Hewitt, CPC-A
Heather Gogo, CPC-A
Heather Groesbeck, CPC-A
Heather Hodgkiss, CPC-A
Heather Rasmussen, CPC-A
Heather Webb, CPC-A
Henry Lathbridge, CPC-A
Hollie Maloney, CPC-A
Holly Mason, CPC-A
Holly Szymula, CPC-A
Holly Vazquez, CPC-A
Hope Wright, CPC-A
Hukum Singh Kachhawa, CPC-A
Ian Mitchell, CPC-A
Ibelice Garcia, CPC-A
Imelda Madrigal, CPC-A
Irene Smith, CPC-A
Iria Escobar, CPC-A
Jackie Coppedge, CPC-A
Jacklyn Wolanski, CPC-A
Jacqueline Hope Kilgore, CPC-A
Jacqueline Arteaga, CPC-A
Jacqueline Monaco, CPC-A
Jacquelyn S Burch, CPC-A
James Sporko, CPC-A
Jamie Addis, CPC-A
Jamie Decker, CPC-A
Jamie Jolissaint, CPC-A
Jamie Morrison, CPC-A
Janet Maempe, CPC-A
Janett Cook, CPC-A
Janice Carado, CPC-P-A
Janice Louann Austin, CPC-A
Janya Yevgeniya Gladu, CPC-A
Jean Mccalmont, CPC-A
Jean N. Mayer, CPC-A
Jeanine Castella, CPC-A
Jeanne Brunner, CPC-A
Jeanne Marie Narkiewicz, CPC-A
Jeffrey Fortier, CPC-A
Jenna Nicole Glenn, CPC-A
Jennifer Matteson, CPC-A
Jennifer A Dungca, CPC-A
Jennifer Ballard, CPC-A
Jennifer Craig, CPC-A
Jennifer Fowler, CPC-A
Jennifer Greenberg, CPC-A
Jennifer Hayes, CPC-A
Jennifer Knapton, CPC-A
Jennifer Miller, CPC-A
Jennifer Mirth, CPC-H-A
Jennifer Riggs-Karr, CPC-A
Jennifer Smith, CPC-A
Jennifer Wilson, CPC-A
Jennifer Xavier, CPC-A
Jenniffer Mason Laster, CPC-A
Jenny Jacobsen, CPC-A
Jenny Moxley, CPC-A
Jere Pilver, CPC-A, CPC-H-A
Jessica Allen, CPC-A
Jessica B Courtney, CPC-A
Jessica Dee Hudson, CPC-A
Jessica L Bolton, CPC-A
Jessica L Park, CPC-A
Jhoanna Lopez, CPC-A
Jill A Nascimento, CPC-A
Jill Fox, CPC-A
Jillaine Cora Dawn Couse, CPC-H-A
Jillian Hanson, CPC-A
Joan Gaspero, CPC-A
Joan R Foster, CPC-A
Joanna Driscoll, CPC-A
Joanna Persse, CPC-A
Joanne Marie Zaroogian, CPC-A
Jocabed Melendez, CPC-A
Jocelyn Lippert, CPC-A, CPC-H-A
Jodie Stackpole, CPC-A
Jody Ann Zabriskie, CPC-A
Jody Pay, CPC-A
Joellen Broderick, CPC-A
John Hall, CPC-A
John Mingus, CPC-A
Newly Credentialed Members
John Robert Thomas, CPC-A
Jonah Gruner, CPC-A
Jonathan Benton, CPC-A
Joni L Andrews, CPC-A
Jose Raul Mangubat, CPC-A
Jose Rosales, CPC-A
Joseph Baron, CPC-A
Joshua Koenig, CPC-A
Joy Fallick, CPC-A
Joy N Ruby, CPC-A
Joyce McManus, CPC-A
Judith Arauz, CPC-A
Judith Pearl, CPC-A
Judy Colon, CPC-A
Judy Filetti, CPC-H-A
Judy Ollom, CPC-A
Judy Quang Keo, CPC-A
Julie Allegretti, CPC-A
Julie Ann Allen, CPC-A
Julie Duncan, CPC-H-A
Julie Karaszkiewicz, CPC-A
Julie Schlesinger, CPC-A
Julie Sutherland, CPC-A
Kalpana Ananthasekar, CPC-A
Kalpana Fotedar, CPC-A, CPC-H-A
Kalpana Payagulla, CPC-A
Kameko Sierra Spencer, CPC-A
Kara Roberts, CPC-A
Karan Singh Rawat, CPC-A
Karen Eidell, CPC-A
Karen H Brower, CPC-A
Karen Klimek, CPC-A
Karen Lessing, CPC-A
Karen Mary Schuster, CPC-A
Kari Hassa, CPC-A
Karissa Beecher, CPC-A
Karla Hughes, CPC-A
Karpagakarthick Muthuramalingam, CPC-A
Kassidi Rios, CPC-A
Kate Paller, CPC-A
Kathe Rees, CPC-A
Katherine Romano, CPC-A
Katherine Zanotti, CPC-A
Kathi E Riggan, CPC-A
Kathie J Grundmayer, CPC-A
Kathleen Brown, CPC-A
Kathleen I Mantia, CPC-A
Kathleen Walsh, CPC-A
Kathrn Lauf, CPC-A
Kathryn Ann Vaske, CPC-A
Kathryn Deuth, CPC-A
Kathryn Geller, CPC-A
Kathy Russell, CPC-A
Kathy Aldridge, CPC-A
Kathy Diane Phillips, CPC-A
Kathy Lotz, CPC-A
Kathy Nelzen, CPC-A
Kathy Vitullo, CPC-H-A
Katie Waycott, CPC-A
Katie Lynn Cox, CPC-A
Katie Oakley, CPC-A
Katrina E Griffiths, CPC-A
Katrina Renee’ Woster, CPC-A
Katy Horton, CPC-A
Kay Wardlaw, CPC-A
Kayla English, CPC-A
Kelley Marie Schilling-Schuld, CPC-A
Kelley Weiland, CPC-A
Kelli Slusher, CPC-A
Kellie Davis, CPC-A
Kellie McDonough, CPC-A
Kelly Graham, CPC-A
Kelly Lane, CPC-A
Kelly Thompson, CPC-A
Kelly Zerlin, CPC-A
Kellye Ward, CPC-A
Kelsey Rainwater, CPC-A
Kelsey White, CPC-A
Ken Brown, CPC-A
Kennisha Armstrong, CPC-A
Kerri Hunsicker, CPC-A
Kerri Jackson, CPC-A
Kerri Lee Magee, CPC-A
Kerry Corneilson, CPC-A
Kevin Fuchs, CPC-A
Kiera Nicole Williams, CPC-A
Kim Romness, CPC-A
Kim B Turner, CPC-A
Kim Bratcher, CPC-A
Kim Hadley, CPC-A
Kim Huckaby, CPC-A
Kim M Hollabaugh, CPC-A
Kimberly Ann Strawn, CPC-A
Kimberly C Stratton, CPC-A
Kimberly Edinger, CPC-A
Kimberly Gartiser, CPC-A
Kimberly H Deweaver, CPC-A
Kimberly Hawkins, CPC-A
Kimberly Karen Lee, CPC-A
Kimberly Kay Bourne, CPC-A
Kimberly Lowe, CPC-A
Kimberly Wade, CPC-A
Kris Stringham, CPC-A
Krishnamoorthy Kuppuswamy, CPC-A
Krishnaveni Ramasubbu, CPC-A
Kristen Jones, CPC-A
Kristi Miner, CPC-A
Kristine Lewis, CPC-A
Kristy Lynne Cotterell, CPC-A
Kristy Lynne Ellsworth, CPC-A
Kyle Bocko, CPC-A
Kyle Sweitzer, CPC-A
Laarni Acosta Bautista, CPC-A
Lakshmi Suneetha Yendamuri, CPC-A
Lam Nguyen-Kingery, CPC-A
Lanie Pagan, CPC-A
Larissa Nelson-Roberts, CPC-A
Latoya Coore, CPC-A
Laura Bertke, CPC-A
Laura Darger, CPC-A
Laura E Woodworth, CPC-A
Laura O’Donnell, CPC-A
Laura Peper, CPC-A
Laura Robertson, CPC-A
Laura Ruiz, CPC-H-A
Lauren Marie Settle, CPC-A
Laurie Wright, CPC-A
Laurissa Burns, CPC-P-A
Lea Baker, CPC-A
Leah Meister, CPC-A
Lecreshia Denae Arceneaux, CPC-A
Lee Schwartz, CPC-A
Lee Spitzer, CPC-A
Leigh Lingbloom, CPC-P-A
Leona Baldwin, CPC-A
Lesli Anderson, CPC-A
Leslie Ebinger, CPC-A
Leslie Marlania Fouts Yingling, CPC-A
Leslie Mutschler, CPC-A
Liliana Flores, CPC-A
Lillian Al-Nawaiseh, CPC-A
Lillian Kathleen Rodriguez, CPC-A
Lillian M Carnes, CPC-A
Lillian Moersch, CPC-H-A
Linda Ballard, CPC-A
Linda Davis, CPC-A
Linda Gail Smith, CPC-A
Linda J Styers, CPC-A
Linda Jo Speed, CPC-A
Linda MacMillan, CPC-A
Linda Pisani, CPC-A
Linda S Nielsen, CPC-A
Linda Thompson, CPC-A
Lindsay Marshall, CPC-A
Lindsay Rogers, CPC-A
Lisa Ballard, CPC-A
Lisa Boihem, CPC-A
Lisa G Rainey, CPC-A
Lisa Gardner, CPC-A
Lisa Kallsen, CPC-A
Lisa Kuraksa, CPC-A
Lisa Marie Williamson, CPC-A
Lisa Martin, CPC-A
Lisa Oliveira, CPC-A
Lisa Salati-Weir, CPC-A
Lisa Shaughnessy, CPC-A
Lisbeht Barrientos, CPC-A
Lissette Duran, CPC-A
Liwayway I Ramirez, CPC-A
Lolita Salgado, CPC-A
Loretta Conner, CPC-A
Lori Bair, CPC-A
Lori Cooley, CPC-A
Lori Kollhopp, CPC-A
Lori L Celesky, CPC-A
Lori Melton, CPC-A
Lori Powszukiewicz, CPC-A
Lorie Stewart, CPC-A
Lorraine T Quan, CPC-A
Louann Sutton, CPC-A
Louisa Haley Horowitz, CPC-A
Lourdes Bautista, CPC-A
Lovina May Byrd, CPC-A
Lue Sharp, CPC-A
Lue Wright, CPC-A
Lura Dye, CPC-A
Lydia Satterfield, CPC-A
Lynne Luck, CPC-H-A
Mabel Velez, CPC-A
Madalen Higman, CPC-A
Magesh Vanchimuthu, CPC-A
Mahreen Ahmed, CPC-A
Maia Karpenske, CPC-A
Maireni Franco, CPC-A
Maja Collins, CPC-A
Maleeha Usman Rafay, CPC-A
Malissa Amend, CPC-A
Mandy Aycock, CPC-A
Mandy Lee Thompson, CPC-A
Mandy Wright, CPC-A
Manoj Prasath Aathupakam Santhanam, CPC-A
Marcelie Martin, CPC-A
Marcella Smith, CPC-A
Marci Perry, CPC-A
Marcia Miller, CPC-A
Marcia Napolitano, CPC-A
Marcy S Wong, CPC-A
Margaret Fontenot, CPC-A
Maria Gonzalez-Husted, CPC-A
Maria I Correa Correa, CPC-A
Maria Mphahlele, CPC-A
Marilyn L Mazzone, CPC-A
Marin P Killoran, CPC-A
Marisela Cruz, CPC-A
Maritza Maldonado, CPC-A
Marjorie Baker, CPC-A
Marjorie St Fleur, CPC-A
Mark Anthony Publico Ferrer, CPC-A
Mark Flores, CPC-A
Marlene Levine, CPC-A
Marsha Shearer, CPC-A
Marsha Turner, CPC-A
Marta Aponte-Rivera, CPC-A
Maruthu Pandian Dhanapal, CPC-A
Mary Jones, CPC-A
Mary Ramaglia, CPC-A
Mary Ann Harvey, CPC-A
Mary Ann Means, CPC-A
Mary Ann Velasquez, CPC-A
Mary Bishop, CPC-A
Mary Coblentz, CPC-A
Mary Colen, CPC-A
Mary Cullen, CPC-A
Mary Grace Arreza, CPC-A
Mary Jane Cromwell, CPC-A
Mary Kay Berry, CPC-A
Mary Portman, CPC-A
Mary Root, CPC-A
Mary Sue Bratton, CPC-A
Mary Swinn, CPC-A
Maureen Hutchison, CPC-A
Megala Mani, CPC-A
Megan Turk, CPC-A
Megan Vredenburgh, CPC-A
Meghan Regan, CPC-A
Melanie Courtney, CPC-A
Melanie Silvestre, CPC-A
MeLinda Stuart, CPC-A
Melissa Beth Paul, CPC-A
Melissa Carolyn Huff, CPC-A
Melissa Cedillo, CPC-A
Melissa Davis Steele, CPC-A
Melissa Lowther, CPC-A
Melissa McHugh, CPC-A
Melissa Montgomery, CPC-A
Melissa Young, CPC-A
Melody Lagervall, CPC-A
Meng Ling Hsieh, CPC-A
Meredith Murdock, CPC-A
Meribeth Bromage, CPC-A
Michael Manda, CPC-A
Michael Aaronson, CPC-A
Michael DuPree, CPC-A
Michaela Manaco, CPC-A
Michele Beard, CPC-A
Michele Bridge, CPC-A
Michele Connett, CPC-A
Michelle Amber Mace, CPC-A
Michelle Billups, CPC-A
Michelle L Torruella, CPC-A
Michelle McShane, CPC-A
Michelle Montrae Davis, CPC-A
Michelle Wells, CPC-A
Mike Hopkins, CPC-A
Mildred I Lawlor, CPC-A
Mimi Gillis, CPC-A
Mindy K Boothe, CPC-A
Miranda Rodgers, CPC-A
Myra Belcher, CPC-A
Naga Navakanth Dasari, CPC-A
Nagabhusnam Raj Perimi, CPC-A
Nancy Cauwels, CPC-A
Nancy Elledge, CPC-A
Nancy Fritz, CPC-A
Nancy J Griffith, CPC-A
Nancy Kaeser, CPC-A
Nancy Korab, CPC-A
Nancy Lisy, CPC-A
Nancy Martinho, CPC-A
Nancy Woody, CPC-A
Naomi Masuda, CPC-A
Natalia Astakhova, CPC-H-A
Neile Acton, CPC-A
Nestor Abraham Olivas, CPC-A
Nga Nguyen, CPC-A
Nicholas Silides, CPC-A
Nicole Britvec, CPC-A
Nicole Marie Lighthart, CPC-A
Nicole Nunn, CPC-A
Nicole Willis, CPC-A
Nikki Lee, CPC-A
Nkonyeasua Mordi, CPC-A
Norman Nepomuceno Lanto, CPC-A
Ozier Lawanda Bodie, CPC-A
Padma Selvi Maniya Gounder, CPC-A
Pamela Adamson, CPC-A
Pamela Ball, CPC-A
Pamela Dalton, CPC-A
Pamela Pringle, CPC-A
Pamela S Spayd, CPC-A
Pamela Williams, CPC-A
Patricia A Wakeley, CPC-A
Patricia Ann Galounis, CPC-A
Patricia Duke, CPC-A
Patricia Morales, CPC-A
Patricia Smith, CPC-A
Patti Shibata-Bardaro, CPC-A
Patty Crispino, CPC-A
Patty Carolina Guerrero, CPC-A
Patty Telgener, CPC-A
Paula Adamco, CPC-A
Paula Rohr, CPC-A
Pauline Poole, CPC-A
Penelope Bowman, CPC-A
Penny J Wilson, CPC-A
Penny McBride, CPC-A
Penny Meeker, CPC-A
Peter Nguyen, CPC-H-A
Phyllis A Bush, CPC-A
Phyllis C Charlie, CPC-A
Phyllis Faucette, CPC-A
Phyllis R Wellington, CPC-A
Pilar Rodriguez, CPC-A
Piper Kroth, CPC-A
Pooja Goel, CPC-A
Priscilla Knotts, CPC-A
Priscilla Secrest, CPC-A
Priyanka Sharma, CPC-A
Qin Li, CPC-A
Rachael Cooper, CPC-A
Rachel Cherie Walker, CPC-A
Rachel Gressel, CPC-A
Rachel Jacobs, CPC-A
Rachel Lynn Zerbel, CPC-A
Rachel McSperitt, CPC-A
Rachel Morningstar, CPC-A
Rachel White, CPC-A
Raghuraman Sundhararaju, CPC-A
Rajendra Kumar Kalva, CPC-A
Rajeswari Muthaiah, CPC-A
Randi A. Schwarz, CPC-P-A
Raziya Daniels, CPC-A
Rebecca Ann Rehl, CPC-A
Rebecca Barnett, CPC-A
Rebecca Keller, CPC-A
Rebecca Lynn Stack, CPC-A
Rebecca Marie Moore, CPC-A
Rebecca Pete, CPC-A
Rebecca Swarts, CPC-A
Rebecca Watson, CPC-A
Reddy Swamyranga Reddy, CPC-P-A
Regan Colwell, CPC-A
Reinaldo Morales, CPC-A
Renee Billingsley, CPC-A
Renu Vora, CPC-A
www.aapc.com
Rhonda J Chambers, CPC-A
Rhonda Lucille Armes, CPC-A
Rhonda McConnell, CPC-A
Rise’ Colleen Dent, CPC-A
Roberta Fletcher, CPC-A
Robin Duffy, CPC-A
Robin L Adams, CPC-A
Robyn Colleen Roeszler, CPC-A
Robyn F Odom, CPC-A
Rochelle Scroggins, CPC-A
Ronald John McKenzie, CPC-A
Ronda Wright, CPC-A
Ronda Johnson, CPC-A
Ronda M Norris, CPC-A
Ronda Reene Davis, CPC-A
Ronique Ashley Hall, CPC-A
Rosemarie Matibag, CPC-A
Rosemary Louise Walton, CPC-A
Rosie Ralston, CPC-A
Ross Alan Hendricks, CPC-A
Roxann Garner, CPC-A
Roxanne C Clark, CPC-A
Roy A Fink, CPC-A
Ruth Hook, CPC-A
Ruthie Dettor, CPC-A
Ryan Kincaid, CPC-A
Ryan Pashelinsky, CPC-A
Sabrina McCoy, CPC-A
Saintly Manalon, CPC-A
Sally Kriss, CPC-A
Sam Presley, CPC-A
Samantha Ayers, CPC-A
Samantha Blanchard, CPC-A
Samantha Sowa, CPC-A
Samuel Harris, CPC-A
Samuel I Gilchrist, CPC-A
Sandra Arcuri, CPC-A
Sandra Bonita Ward, CPC-A
Sandra Clark, CPC-A
Sandra Copple, CPC-A
Sandra Louise Kaye, CPC-A
Sandra Tourtellotte, CPC-A
Sandra Turner, CPC-A
Sandy Phillips, CPC-A
Sandy Mabry, CPC-H-A
Sara Ann King, CPC-A
Sara Lynn Bowman, CPC-A
Sara Madsen, CPC-A
Sarah A Trotto, CPC-A
Sarah Gibson, CPC-A
Sarah L Robbins, CPC-A
Saravana Kumar Kirubanandhan, CPC-A
Saravanaraj Muthalagan, CPC-A
Saritha Ponnemaina, CPC-A
Scarlett von Hofen, CPC-A
Scott Jondahl, CPC-A
Scott Lineback, CPC-A
Scott Livingood, CPC-A
Sean Delthony, CPC-A
Sean Sabo, CPC-A
Sean D Lytle, CPC-A
Selena Goodness, CPC-A
Selvarasu Ramanathan, CPC-A
Senthilkumar L P, CPC-A
Sevgi Davud, CPC-A
Shallen Storms, CPC-A
Shanna Lang, CPC-A
Shannon King, CPC-A
Shannon Ristine, CPC-A
Shannon Rose Westover, CPC-A
Shannon Becker, CPC-A
Shannon Noell, CPC-A
Shannon Russell, CPC-A
Shari Hull, CPC-A
Sharon C Bratton, CPC-A
Sharon Copland, CPC-A
ShaShanta Smith, CPC-A
Shawn Palmer, CPC-A
Shawn Patrick O’Neill, CPC-A
Shayna Brawner, CPC-A
Sheila Fellah, CPC-A
Sheila Hand, CPC-A
Sheila Iodice, CPC-A
Sheila Miranda Dove, CPC-A
Shelli Huff, CPC-A
Shelli Russell, CPC-A
Sheri Harwood, CPC-A
Sherri Brindle, CPC-A
Sherrie Jo Williams, CPC-A
Sherrizah Fernandez Solis, CPC-A
Sherry Klinedinst, CPC-A
February 2012
47
Newly Credentialed Members
Sherryann Richards, CPC-A
Sheryl L Green, CPC-A
Simone Latrice Short, CPC-A
Sivaprabha G M, CPC-A
Slobodan Simikic, CPC-A
Soban Babu Rajasekaran, CPC-A
Sonya Scales, CPC-A
Sorina LaDale Robinson-Clark, CPC-A
Srikanth Goud Laxmidevi, CPC-A
Srilata Gutta, CPC-A
Stacey Parker, CPC-A
Stacia A Winegardner, CPC-A
Stacy Shireman, CPC-A
Stacy Stohon, CPC-H-A
Stefanie E Henne, CPC-A
Stefanie Rager, CPC-A
Stephanie Dubbs, CPC-A
Stephanie Frye, CPC-A
Stephanie Reeves, CPC-A
Stephanie Whitsel, CPC-A
Subashini Nithyaprasad, CPC-A
Sue Ann Duck, CPC-A
Sue Fackler, CPC-H-A
Summer Stout, CPC-A
Sunil Kumar Nimmathi, CPC-A
Susan Dormont, CPC-A
Susan A Stramiello, CPC-A
Susan B Sturdevant, CPC-A
Susan Bergman, CPC-A
Susan DelMastro, CPC-A
Susan E. Molitor, CPC-A
Susan Ellis, CPC-A
Susan Lewis, CPC-A
Susan Lynn Benzel, CPC-A
Susan Lynn Hartl, CPC-A
Susan M Sousa, CPC-A
Susan Melo Dasilva, CPC-A
Susan Parker, CPC-A
Susan Redden, CPC-A
Susan Rogers, CPC-A
Susan Szelestei, CPC-A
Susan Walden, CPC-A
Susan Wheeler, CPC-H-A
Susanne Salese, CPC-A
Suzanne Loeb, CPC-A
Sylvia M Strohmeier, CPC-A
Tajuana Roper Huling, CPC-A
Tamara Polychronis, CPC-A
Tamara Yount, CPC-A
Tameka Lasha Griffin, CPC-A
Tammany E.L. Krause, CPC-A
Tammy Leeks, CPC-A
Tammy Meyer, CPC-A
Tammy Whiting, CPC-A
Tanika Jeanette Cornish, CPC-A
Tanja Broom, CPC-A
Tanya Fleury, CPC-A
Tanya Rebelo, CPC-A
Tara J Schroeder, CPC-A
Tara L Schiller, CPC-A
Tasha Brace, CPC-A
Tasha Todd, CPC-A
Teresa Anderson, CPC-A
Teresa Pacey, CPC-A
Teresita Endoso, CPC-A
Terri Layne Hicks, CPC-A
Terri J Leighton, CPC-A
Terri L Baron, CPC-A
Terri-Lynn Marie Logan, CPC-A
Terry Ellen Bailey, CPC-A
Thelma Brantley, CPC-A
Theresa Kaufmann, CPC-A
Theresa Maria Rivera, CPC-A
Tiffiney R McDaniel, CPC-A
Tina Grimm, CPC-A
Tina Nimeh, CPC-A
Tina Roy, CPC-A
Tina Sapinoso, CPC-H-A
Toni E Ortiz, CPC-A
Toni Edmundson, CPC-A
Toni Smith, CPC-A
Tony Sigman, CPC-A
Tonya Danielle Cosby, CPC-A
Tonya Tavernaro, CPC-A
Tosha Taylor, CPC-A
Tracy Bartholomew, CPC-A
Tracy Boyer, CPC-A
Tracy Duray, CPC-A
Tracy Ellington, CPC-A
Tracy Horn, CPC-A
Tracy L Winterhalter, CPC-A
Tracylyn Williams, CPC-A
Tricia Wade, CPC-A, CPC-H-A
Trista Burney, CPC-A
Troy Wilson, CPC-A
Trudy Stevens, CPC-A
Udhayakumar Palani, CPC-A
Valerie Mast, CPC-A
Vanessa Freeman, CPC-A
Vanessa Ruiz, CPC-A
Velshi Renee’ Smith, CPC-A
Veronica Miskimen, CPC-A
Veronica Raigoza, CPC-A
Vicky Myers, CPC-A
Victor James Marasa, CPC-A
Victoria Dowswell, CPC-A
Vijayapriya Ramesh, CPC-A
Virginia Sarnowski, CPC-A
Vivian M Newman, CPC-A
Vynnie Washington, CPC-A
Wanda Bailey, CPC-A
Wanda Cure, CPC-A
Wanda Griffie, CPC-A
Wendy Sue Mclaughlin, CPC-A
Wendy Kennedy, CPC-A
Whitney Elise Nowlin, CPC-A
Willetta Snell, CPC-A
William Short, CPC-A
Yoko Jackson, CPC-A
Yvette Martin, CPC-A
Zabrina Lyn Costello, CPC-A
Zairy Vaquera, CPC-A
Zdenka Jonic, CPC-A
Specialties
Aimee Agee, CPC, CANPC
Alarie Santos, CIMC
Alyssa Megan Easterwood, CRHC
Amanda Rhodes, CPC, CPC-P, CPMA
Amanda Sorge, CPC-H, CPC-P, CPMA
Amelia Toaisi, CPCD
Amie Stanley, CPC, CPMA
Ana Madeleyne Prada, CPC, CPMA
Angela D Deyling, CPC-A, CEDC
AnnMarie Charles, CPC, CUC
Arlene Kelly, CPRC
Barbara Gonzalez, CPC, CPC-H, CPMA
Barbara Reed, CPC, CPCO
Belinda B Shannon, CPC, CPMA, CPRC
Bill N Cox Jr, CPC, CPCO, CPMA
Bonita L Eshbaugh, CIMC
Brandi Lynn Tadlock, CPC, CPCO, CPC-P, CPMA
Carmen Larimore, CPMA
Carol Margeson, CPC, COBGC
Carrie Hatfield, CPC, COSC
Catheryne I Stormo, CPC, CPCO, CPMA
Charline Rambaud, CPC, CPMA, CEMC
Cheryl Ann Schofield, CPC, CPMA
Cheryl Baldia, CPC, CPMA
Christina Matsiga, CPC, CPCO, CPMA
Christina R Allen, CPC, CPMA, CEMC, COSC
Colleen Lodato, CPC, CPMA
Colleen O’Neill Hall, CPC, CIRCC, CPMA
Courtney Steen, CPC, CPMA
Crystal Lewallen, CPC, CCC
Cynthia Rudd RMC, CPC, CPC-P, CPMA
Darcy L Carter, CPC, CPMA
Daria A Fanelli, CGIC
Debra R Spinetti, CPC, CGIC
Desiree Dabovich-Larranaga, CPC, CGSC
Diana Mason, CIRCC
Diane M Minard, CPC, CEMC
Eileen Lambert, CIRCC
Elizabeth A Hollingshead, CPC, CUC
Eric Quivers, CPC-A, CPMA
Eung Kim, CPC-A, CIRCC, CPMA, CEMC
Fariba Vadpey, CPC, CANPC
Gail P Duell, CPC, CEMC
Genni Ourth, CFPC
Ignatia N Agus, CPC, CCC
Jason Robert Sharpe, CPC, CPMA
Jeannette Connell, CPC, CEMC, CFPC
Jennifer Crouch, CPC, CCC
Jennifer L Hill, CPC, CEMC
Jennifer Rae Wilson, CPC, CPCO
Jocelyn I McVey, CPC, CPMA
John Edge, CPC, CPMA, CEMC
Joli Fitzgibbons, CPC, CEMC
Judith E Moore, CIRCC
Judy A Etgen, CPC, CGIC, CGSC
Judy A Wilson, CPC, CPC-H, CPCO, CPC-P,
CPC-I, CANPC
Justine Rosales, CPC, CANPC
Karen S Ferguson, CPC, CPC-H, COSC
Karyn Cardenas-Foray, CPC, CPMA, CEMC, CIMC
Kay Elizabeth Walker, CPC, CEMC
Kelly R Dobesh, CPC, CIRCC
Kimberly Litteral, CPC, COSC
Kortni Huber, CEMC
Kristine Nystrand, CPC, CPMA
Laura Devries, CPC, CANPC
Laura Sprenger, CIRCC
Lea A Renegar, CPC, CGIC
Linda Ann Rooney, CPC, CPMA
Lisa M Jessop, CPC, CEMC
Lisa M Roche, CPC, CEMC
Lynn M Wilks, CPMA
Mandy Wiebe, CPC, CPEDC
Marcia Carlson, CANPC
Mari F Vitale, CPC, CPCO
Marilyn Fremgen, CANPC
Mary Dean Ryles, CPC, CPMA, CPC-I
Mary Kay Jeskey, CPC, CIRCC
Mary Lou Wojciechowski, CCC
Matthew Case, CPCO
Melinda Leckrone, COSC
Melissa McDonnell, CPC, CANPC
Melissa Troiano, CPMA
Michelle Isaacs, CPMA
Michelle Moreno, CIRCC
Mishelle Rennie, CRHC
Nancy L Barnes, CPC, CGSC
Natalie Kessler, CPC, CPRC
Natasha Finn, CPC, CPC-H, CPMA
Nelson Mark Braslow, CPC, CPMA
Nicole Marie Soto, CRHC
Pamela Asbury, CPC, CPMA, CPC-I
Pamela Warren Impson, CPC, CEDC
Pamela Wright, CPC, CPCD
Patricia G Mirolo, CPMA
Paula Roberts, CANPC
Rachel R Fernandez, CPC, CPMA
Rebecca Huffman, CPC, CANPC, CEMC
Renay E Walker, CPC, CPCO
Robin Wicevic, CCC
Rodolfo W Borges Gomez, CPC, CPMA
Rosemary Nease, CPC, COSC
Ruth C Cambra, CPC, CASCC, CEMC
Sally Streiber, CPC, CEMC
Sandra L Fake, CPC, CPMA
Sara Marie McComas, CPC, CPMA, COBGC
Sarah Song, CPC, CPMA
Sharon L Benyo, CPC, CEMC
Sharvette Walker, CPC, CPMA
Shawna Ramey, CPC, CPMA
Shelly M Smith, CPC, CHONC
Sheri L Freeman, CPMA
Sherry Lynn Swain, CPC, CPMA
Sherry Rose Naldrett, CPCO
Sima Marzie Taheri, CPC, CGSC
Siu B Chu, CPC, CPMA
Sonda Kunzi, CPC, CPMA
Stacey Lynn Patterson, CPC, CGIC
Stacy M McCall, CPC-H, CGSC
Stephanie Ann Erstad, CPC-A, CPMA
Stephanie G Joiner-Smith, CPC, CEMC
Sundra S Jones, CPC, CPCO, CPC-P, CPMA,
CPC-I, CHONC
Sunni M Hearin, CPC, CEMC
Susan Elias Capone, CIRCC
Susan L Reehill, CPC, CPMA, CEMC, CHONC
Tammy Luttenberger, CPC, CPMA
Tatiana Bovgirya, CPMA
Tatyana Sushkina, CPMA, CEMC, COBGC
Theresa Marie Bramhall, CPC, CEMC
Tina Burns, CPC, CPCO
Traci Alwell, CPC, CIRCC
Tracy L Reedus-Morrow, CPC, CIRCC
Trisha Ruppersberger, CPMA
Valri Anne Cooper, CPC, CPMA
Vicki R Davis, CPC, CPMA
Vijay Bapatla, CPC, CPMA
Wendy A Bartko, CPC, CPMA
Yasmeen Soin, CPC, CPCO
Zulema Perez, CPC, CPMA
Magna Cum Laude
Adrianna Verble, CPC-A
Alexander Rojas, CPC
Amethyst Kathleen Kress, CPC-A
Andy Buck, CPC
Angela Wethern, CPC-A
Ann Pommer, CPC-A
Brandi Sloots, CPC-A
Carrie Wilson, CPC
Christa Zuleger, CPC-A
Christina Brooks, CPC-A
Dairys Ramirez, CPC-A
Dawn Witschen, CPC-A
Denise Michelle Smith, CPC-A
Diane Elvidge, CPC-A
Elaine T Damato, CPC
Glorivee Cartagena, CPC-A
Heather Hanna, CPC
Holly D Moody, CPC
Jasmine Sessions, CPC-A
Jennifer Holterman, CPC
Joanne L Burns, CPC
Jorge Cesar Troche, CPC-A
Joseph Sivak, MD, CPC
Karen Hale, CPC
Kathleen Collins, CPC-A
Krishelle S Pollard, CPC-A
Lisa Jados, CPC-A
Liuba Quevedo, CPC-A
Llilian C Gonzalez, CPC-A
Lois Fox, CPC-A
Lorri R Tobin, CPC-A
Margaret Novack, CPC
Marie Cheeseman, CPC-A
Martha (Marty) Ann Turnage, CPC
Marvelin Romero, CPC
Megan Chisholm, CPC, CPC-H
Michele Harville, CPC
Michelle A Palmer, CPC-A
Pamela Colbert, CPC-A
Pedro O Sanchez, CPC
Phyllis Yang-Cashman, CPC-A
Rebecca Rose Scotellaro, CPC-A
Robin Messina, CPC-A
Rolando Gutierrez, CPC-A
Sandra Rodriguez, CPC
Sarah Clark, CPC
Shelby Saldivar, CPC
Shelley Dawn Collier, CPC
Tania Lopez, CPC-A
Tara Guinn, CPC-A
Tracy Murphy, CPC-A
Coder’s Voice (continued from page 44)
Make Your Own
Play Dough
2 cups flour
2 cups warm water
1 cup salt
2 tablespoons vegetable oil
1 tablespoon cream of tartar
Food coloring
48
AAPC Coding Edge
Engage Hearing
Have the students read articles in Coding Edge or other materials out loud. The material
should relate to the body system they are studying. By hearing the medical terms used and
pronounced correctly, students retain the information longer.
There are several ways to teach. Keeping students physically engaged will ensure they
learn—not just memorize—the medical terminology they will need to know for their entire career.
Geanetta Johnson Agbona, CPC, CPC-I, CBCS, is a medical billing and coding instructor in Charlotte, N.C. She was recognized as “Instructor of Distinction” in 2010. She co-owns CGS Billing Service with her spouse, Charles Agbona. You can read her
blog at www.cgsbillingservice.blogspot.com.
AAPC 2012 NATIONAL CONFERENCE
LAS VEGAS, NV
APRIL 1 - 4
$795 FOR MEMBERS
70+ Sessions | Up to 18 CEUs | Networking | Meals Included
www.aapc.com/lasvegas
PRE-CONFERENCE EVENTS: CPC-H Boot Camp | Proctored Exams | ICD-10 Implementation Boot Camp
Minute with a Member
Thelma Stewart, CPC-A
Medical Billing Representative, Azalea Health Innovations, Inc., Savannah, Ga.
Tell us a little about yourself.
My background was in logistics and customer service. As the economy changed, I
decided to go back to school to further educate and innovate myself for a promising
career. Since I had always wondered who
works behind the scenes to ensure a patient’s visit is properly billed to insurance
companies and that the provider receives
the proper reimbursement for the services rendered, I looked into medical billing
and coding. I attended Ultimate Medical
Academy (UMA) and received a technical
diploma in Medical Insurance Billing and
Coding. I worked two jobs while attending UMA. Immediately after graduation I
prepared to take the Certified Professional Coder (CPC®) exam. I passed on my first
try. As a Certified Professional Coder-Apprentice (CPC-A®), I had a hard time finding employment because of my experience
level. I started out billing for home health
care through a temp agency, but it was very
different from what I was taught. Eventually, I was offered a position as medical biller and coder with a great software company, Azalea Health Innovations, Inc. The
company offers billing and coding services to providers of all specialties and encourages and supports continuing professional
education. I am now working on a bachelor’s degree in Health Care Administration.
What is your involvement
with your local AAPC chapter?
I attend the local Savannah, Ga. chapter. I
was very happy to see how welcoming they
are to new members. We operate as one
body for full support to all. Dorothy Carswell, CPC; Faye Grile, CPC, CPMA,
CEMC, and AAPCCA Board of Director
Freda Brinson, CPC, CPC-H, CEMC,
50
AAPC Coding Edge
have been very supportive to me. I have
learned so much from our workshops, as
well as from the speakers who volunteer
their time to teach us additional information in their specialty. Networking is our
chapter’s best tool.
What has been your
biggest challenge as a coder?
The biggest challenge CPC-As face is gaining employment. Helping employers understand that although we do not have the vast
knowledge of a veteran biller or coder, it is
not hard to learn. The fact that we are certified speaks volumes. Coding is not easy, and
passing the test also is not easy. If you allow
someone to keep building off their knowledge, you just may have a winner on your
hands. I have learned a lot from my mentor,
Michelle Hodges (AAPC-approved). I am
thankful that my employers saw potential
in me and gave me the opportunity to prove
myself. The next time you see an application for a CPC-A, do not underestimate
the knowledge they have. The investment
they’ve made in their education is sincere.
We truly want to help your practice thrive.
What AAPC benefits
do you like the most?
AAPC online forums offer a great deal of insight into coding issues and questions. Coding Edge magazine, EdgeBlast, and Billing
Insider are very vital resources that keep me
current with current updates on everything.
September’s Coding Edge helped my company bring in revenue to several providers that
could have been lost. In particular, the article on coding health risk assessment (HRA),
“Know What HRA Services Are Included
in Preventive Medicine Counseling,” was
very helpful.
How is your organization
preparing for ICD-10?
My organization, Azalea Health Innovations, is a software company that develops
revenue cycle management software that is
both Health Insurance Portability and Accountability Act (HIPAA) 5010 and ICD10 ready. They provide educational material
for clients and employees through a monthly newsletter and training videos to inform
them about upcoming changes and requirements for ICD-10. My employer sees to it
that we have ICD-10 Connect and keeps a
lookout for up-and-coming webinars and
workshops we can attend to stay informed.
They also research the Centers for Medicare & Medicaid Services’ (CMS’) website
as well as commercial payers’ websites to educate everyone on how ICD-10 will affect
both payers and providers. ICD-10 will be a
huge change, but I believe it will better prepare us for what lies ahead.
If I could do any other job,
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