Our First Issue

by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS CRN Founder & CEO

Welcome CRN Associate!

Thank you for making the first issue of the newsletter a success! We heard from many of you and appreciate your feedback.

The results of the poll regarding the format of the newsletter came in at 85.7% voting to keep the newsletter in one long page rather than breatking it up with <more...> links for the longer articles. So we will stick with this format for now. Thanks to those who participated in the poll!

An exciting new statistic came from visitors to the CRN Discussion Forum on the web - we hit an all time high of 400 simultaneous users on August 16th, 2005! Prveviously it was 109 in January - Wow!

One reader suggested we have a job posting area. We have had job posting area since 1999. We're hoping with this newsletter and word of mouth that this feture will be utilzed more. The CRN is one of the few sites on the internet that does this for free. Check it out! (Note - no job postings should be made to the listserv on the web forum area.)

To view or comment on any newsletter issues visit the discusion board.

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ListServe Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

On the list this week, we tackled a lot of code specific questions. It looked as though all were gratefully answered. There were some ICD-9 code questions as well as several CPT and HCPCS.

We had an Evaluation and Management question come up (my favorite). A cardiovascular Surgical Consult was the category and the History of the Present Illness needed deciphering. As first it appeared that the note was a brief history, but after pulling it apart, it was definitely extended. Here’s the note, see what you would do: “The patient is a 50 y/o female who presented through an outside hospital yesterday morning with chest pain relieved by nitro. She was found to have transient inferior ST-T changes. She was transferred here and had a cardiac cath last night which showed critical stenosis of the RCA and moderate stenosis in the LAD and left circx system of 80%. Left ventricular function was good. Pt has been pain free since the cath. Pt was on IV integrilin, 300mg Plavix, IV heparin & Nitro drip.” The breakdown can be found at the end of the column.

The big topic this week was an “incident to” scenario. It continued throughout the week with many participants offering opinions. The scenario dealt with an ARNP, CNS and an MSN. The MSN is not yet credentialed by the insurance company yet. Can the MSN’s be billed “incident to” the ARNP’s? They are not employed by the same company. The conversation continued that the MSN’s work would be done only in the hospital and even if part of the same employer, there are no “incident to” services in the hospital. The MSN (LSW) services are usually bundled into Nursing Homes services as well, and this only further complicated this scenario. Friday showed us a different side to this scenario-what if the one employee is leased? Does this change the possibilities? What do you think?

And lastly, another topic racing around was refunding Blue Cross/Blue Shield on old claims. One lister was being asked to refund a visit from 2003 because of a pricing change. Someone else had a situation where the insurance was requesting a $.02 refund or it would be off-set!!! That’s interesting!?! A more complicated scenario was one in which the insurance company was requesting a refund from several years back when it was determined that the patient had Medicare primary. The patient only had part A and is not reachable at this time. The frustration level was high as the listers were conveying their stories. The research needs to go into these situations and challenged if incorrect.

Selective and non-selective catheters were also explored. The differences are that a non-selective is place directly into the vessel under study. It’s not moved or manipulated. The selective placement can be moved into an artery other than the aorta or the vessel it started in.

As always, thanks to all who participated. We saw a few new names and some interesting questions. Hope to see more in the coming weeks. Again, if you’re not familiar with the list serve, come for visit!

Joining the list serve: $0
Asking questions on the list serve: $0
Advice given: Priceless

Here’s the answer to the HPI post that was described above.

Location: Chest
Modifying factor: Nitro
Duration: Yesterday morning
Severity: Moderate stenosis
Timing: Pain free since stenosis
Signs/Symptoms: Transient inferior ST-T changes

Until next time, I’ll see you on the list!!

*I’ll be visiting with Mickey Mouse next week. So you’ll see this column when I return the following week.

Suzan

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TeleWebinar Update

by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME President, CRN Continuing Education, Inc.

CRN Continuing Education, Inc.

We've had a busy week putting together TeleWebinars at a low cost for our membership. We've gotten our first approvals for CEU credit by the AAPC and have scheduled more great topics. Things are really moving along.

We need your help though. Tell us what topics you want us to develop by visiting this link. Or ask a question at our "Ask The Expert" page and we will develop content around YOUR issues. We have experts standing by ready to create a presentation around what you want and need to know. They will do the research and package it up for you in an exciting presentation. This is participant driven content - so tell us what you want to know!

Once we reach 100 suggestions we will do a random drawing online and give away attendance to one CRN TeleWebinar for free! So take 5 and give us your suggested topics or questions for the experts!

Remember all you need is a phone to participate. Optionally you can be on the internet and watch the show as the presenter advances their slides - just as if you were at a live event. We've put a demo together of what a presentation will feel like. This is also what the recorded version of the TeleWebinars will be like should you not be able to attend live but want the content. You will earn CEU credit either way. Click here to try it out.

Upcoming Topics:

• 9/13/05 Modifier$ - It's All About The Money! by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS
• 9/20/05 Time For Change: ICD-9-CM 2006 by Joann Baker, CCS, CPC-H, CPC, CHCC
• 9/27/05 The NCCI - What is it, and How Do I Use It? by Deborah Grider, CPC, CPC-H, CPC-P, CCS-P, CCP
• 10/19/05 Orthopaedic Arthroscopic Surgical Coding by Annette Grady, CPC, CPC-H
• 10/25/05 The New Appeals Process Under Medicare by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHMBE

Upcoming Speakers - Dates to be set

• Suzan Hvizdash
• Pam Biffle
• Nancy Reading
• Quin Beuchner

Join our CEU Notification List to be notified when new topics are added.

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Institute News

by Pam Biffle, CPC CRN Coach

We enrolled several more students this week at the CRN Institute. Our most popular course is the Physician Based Medical Coding Course designed for those preparing for the various physician based board exams like the CPC or CCS-P.

There are a few more days left (expires August 31st, 2005) to take advantage of the $700 beta tester rate (compared to the regular $1995 price) for the following courses:

Medical Billing
Physician Coding
Hospital Coding

We are putting together a group for our new Chart Auditing Course that will start in January. The first time we teach this course will be in the TeleWeb format where students will meet with the instructor once a week for 10 weeks by phone and web - using the same interface as our TeleWebianrs. We are offering a discount for the first run of this course to readers of this newsletter. To be put on the interest list send an e-mail to crn501coach@crn-institute.com and when it's time to enroll you will be notified.

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CRN Member Highlight

Jo Ann Steigerwald RHIT, ACS-OH, ACS-GI

Read Jo Ann Steigerwald's interview:

Where are you from?

Baraboo Wisconsin

Spending time with my family and friends at home. I’m also a Red Hat Lady, and have a lot of fun there.

Do you have any hobbies?

I love to cook, and I write fiction.

What credentials do you hold?

RHIT, ACS-OH, ACS-GI

What organizations do you belong to and how have they helped your career?

AHIMA which has marvelous resources and educational programs, and of course support for members. I’m also a Board member for the Board of Advanced Medical Coding.

How did you get into the field of medical billing and coding?

I started out in hospital medical records, and of course, we always coded the hospital charts, so I was already in the field when coding became the cornerstone of reimbursement systems.

What is your current position?

I am a consultant with my own consulting firm, Medical Business Specialists.

What is one of your accomplishments in this field that you are most proud of?

All of the people I’ve had the privilege to meet and teach in my seminars. I’ve always been most fortunately to have excellent teachers and mentors, and it has been my privilege to pass on what others have given to me.

What do you find most exciting about this field?

The growth and challenges of keeping up with it all, not just with the codes themselves, but the changing technology, terminology and payment systems.

What do you find most frustrating?

Waiting for ICD-10-CM to be implemented.

What do you feel the future holds for this field?

A world of new challenges, we have emerging technology to keep up with in health care, new coding systems that will come into use, and new payment systems to deal with such as the one that will becoming out for Ambulatory Surgical Centers. And excellent job security: I don’t believe we will every have enough qualified people to do all the work that needs doing.

What would you tell someone just starting out in this field?

First, to learn the material very, very well There is nothing as valuable as quality education as a foundation to build upon.

Second, always continue to learn, and to help others to learn, because none of us were born knowing this material, and none of us ever knows it all.

Third to always maintain your integrity. There is nothing as valuable as knowing for sure that you will never compromise yourself, and nothing as sad as knowing you have.

If there was one thing you could change about this field what would it be?

I’d provide more quality educational opportunities for all of us.

Who do you consider a mentor?

Oh SO many people, starting a ladies, named Mary McCandliss and Helen Eagles, back when I was just starting out, my instructors at Truman in Chicago (people I still call upon) and so many who are experts in so many different areas of our field. But truthfully, a mentor is a teacher and a guide. So everyone who answers a question when I need help, and asks a question that I cannot answer and have to look up or wait for someone else to answer is in that capacity for me.

What is your affiliation with the CRN and how has that helped you?

I’ve been a member of CRN from the time it started and it’s been a pleasure to see it grow and prosper. The most important benefit for me is the incredible array of resources that I find with in the group. We have members who are expert in all fields of coding and reimbursement, but also in the peripheral areas that are very important to all of us. Recently I needed some specialty coders for an audit project and Barbara graciously and generously helped me find exactly the experts I needed for my project. And of course, I always appreciate work that comes to me through people who know me from CRN participation.

What is your favorite billing or coding product?

Hands down the Encoder Pro Expert software package. It has CPT, ICD-9-CM, HCPCS, NCCI edits, fee schedule and modifier information, cross-codes, and LMRP information as well as “lay” surgical descriptions. I can cut and paste from it which saves me a LOT of time in preparing reports and presentations (and saves me from potential typos!) but also has a feature where I can add notes to codes, and best of all, when the soft ware is updated, my notes transfer too. This package has completely eliminated the need for me to carry coding books when I’m working on client site.

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Dear Cody

This column contains questions from the CRN Newsletter readership. Click here to submit your issue and perhaps Cody can help. Read on for this weeks question:

Dear Cody, I am an RN nurse auditor but not certified in coding. I am emplpoyed by a very large county hospital district. I get "request audits" from AR asking me to do what are non-clinical tasks from transferring suffix charges to different dates of services to "posting" procedures omitted from bills - including adding obsevation charges on patients that are medicaid reversals. My question is: Can I route these requests to the coding department? We are in the process of creating procedures and my position is that coders should recieve back their own errors in posting or adjusting observation hours instead of the nurse auditor. Nurse auditors are not always coders but are expected to be familiar w/it. As you may know, we concentrate on high dollar accounts, defense audits, departmental revenue and documentation documentation/compliance issues. Coding is a specialty and I think coding departments should QA the mistakes to learn from them. I don't understand why Nurse Auditors QA and try to fix their work. Can you help me understand why the process of NA's correcting coder's work might be the norm in some large hospital networks? Thank you!!! Allison, RN PS love your site and news letter! I need all the info I can get!

Cody Replies: That’s a great question Allison. You have to look at the specific issues and possibly assign certain issues to coders and keep the others. Are they asking you to correct a date because of the patient’s admission status? This would be something for the NA not the coder. Are they asking about clarifications needing done in the medical record as opposed to the actual codes being submitted? This would also be the NA’s responsibility. The nurse auditor is usually the one communicating with the Hospitalists more regularly than the coder (although not always a good thing). The coder should understand these situations, but the NA might want to be the one to investigate to determine who should make the correction. In some larger practices the physicians secretaries are often asked these questions. (Not an appropriate source or use of their time.)

You are right the coders should fix their own work, however, you might want to look at where the problem stems before shipping it to the coding staff for correction. Thanks for your question!

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Humor

by Chip Cooper. You can find more cartoons by Chip Cooper at: Coopertoons

Submit your joke here.

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