Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associate!

Boy these weeks fly by when you try to get a newsletter out each week.

I have an announcement that I think is exciting but then again I'm a bit of a geek. :) The CRN Web Forums now have a new CRN-L Forum where all of the CRN-L e-mails are being archived. This is great for two reasons:

1) Some can't join the list because their job won't allow that many e-mails to come through. Now they can go to the web and see what is being discussed.

2) Now when you search the CRN Web Forums CRN-L posts will be included in that search making our "virtual filing cabinet" even more useful. I don't know if you've tried to find an old CRN-L post on yahoogroups but it is a pain. Now it will be easy with the CRN Search engine.

Now you know what all those test messages were about.

We hope you find these weekly newsletters informative and entertaining. Please share your comments with us - we will listen.

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Listserv Lately

by Margie Vaught, CPC, PCE , CCS-P, MCS-, ACS-OR, CPC-H

Because our regular columnist Suzan Hvizdash was on vacation last week we decided to reprint this very important post from Margie Vaught:

Hey the proposed fee schedule came out August 8th and it is scary guys...

Here is where you can send comments -- PLEASE everyone have your physicians send comments:

You may submit comments in one of three ways (no duplicates, please):

1. Electronically. You may submit electronic comments on specific issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments.

(Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.)

2. By mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1502–P, P.O. Box 8017, Baltimore, MD 21244–8017.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1502–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.

4. By hand or courier. If you prefer, you may deliver (by hand or courier)your written comments (one original and two copies) before the close of the comment period to one of the following addresses:

Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201;

or 7500 Security Boulevard, Baltimore, MD 21244–1850.

If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786–7197 in advance to schedule your arrival with one of our staff members.

(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

Submission of comments on paperwork requirements. You may submit comments on this document’s paperwork requirements by mailing your comments to the addresses provided at the end of the ‘‘Collection of Information Requirements’’ section in this document.

This is why:

The casting supplies that they are now going to go back and bundle them back into the surgical codes.

If this happens it is going to be harder and harder to get reimbursed for  the over-head expenses.  Right now many of the private carriers are starting to use the Q codes and if they are deleted this will again leave  Orthos losing money big time on casting supplies.

Here is the URL for the proposed changes and if you down load and then go to master and find and word 'casting' you will find this section..

http://www.cms.hhs.gov/physicians/pfs/default.asp

Here is what it says:

"For this reason, it is imperative that the relevant medical societies review the “Direct Practice Expense Inputs” on our website at www.cms.hhs.gov/physicians/pfs (under the supporting documents for the 2006 proposed rule) and provide us with feedback regarding the appropriateness of the type and amount of casting and splinting supplies. We are also requesting specific information about the amount of casting supplies needed for the 10-day and 90-day global procedures, because these supplies may not be required at each follow-up visit; therefore, the number of follow-up visits may not reflect the typical number of cast changes required for each service.

The following cast and splint supplies have been reincorporated as direct  inputs: fiberglass roll, 3 inch and 4 inch; cast padding, 4 inch; webril (now designated as cast padding, 3 inch); cast shoe; stockingnet/stockinette, 4 inch and 6 inch; dome paste bandage; cast sole; elastoplastroll; fiberglass splint; ace wrap, 6 inch; and kerlix (now designated as bandage, kerlix, sterile, 4.5 inch) and malleable arch  bars. The cast and splint supplies have been added to the following CPT codes: 23500 through 23680, 24500 through 24685, 25500 through 25695, 26600 through 26785, 27500 through 27566, 27750 through 27848, 28400 through 28675, and 29000 through 29750."

You all know that I hate math... but doing simple math of 10 casts per week, offices could be losing $1000 per month in just supplies.  And in the budget neutral RVU rules how are they going to increase the RVUs for these codes without decreasing the value of other surgical codes.

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TeleWebinar Update

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

CRN Continuing Education, Inc.

Much work is going on behind the scenes putting the CRN TeleWebinars together at a low cost for our membership.

We need your help though. Tell us what topics you want us to develop by visiting our "Topic Request" page. 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!

Some topics suggested last week via our "Topic Request" page were:

• Chart Auditing
• ICD-10-CM
• Diagnosis Coding for Radiology & Pathology (professional fees)
• Pass Through Codes - Billable vs. NonBillable

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

Interested in becoming a speaker? E-mail me.

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 had quite a few students from Drexel finish this past week and their certificates are being mailed today! A new group starts the week of September 26th. E-mail Laureen if you are interested in joining this group.

Our Physician-Based Medical Coding class part 2 resumes at Christiana Healthcare in Deleware Thursday September 8th. New classes are being formed for January. E-mail Laureen if you are interested in joining this group.

Tomorrow is the last day to take advantage of the August beta tester discount ($700 instead of $1995) for our online coding and billing courses then it goes up by $100 for the month of September. These are the courses available with the discount:

Medical Billing
Physician Coding
Hospital Coding

We had a major upgrade to our online course area from BlackBoard 5.0 to BlackBoard 6.0. Our practice tests were not pulling correctly from the test pool but that has now been corrected.

We shipped several orders of the 2005 Coding Certification Review Blitz DVDs. What's nice about this version is you can play the DVDs on your computer DVD player or TV DVD player. CRN Gold Member Discounts apply!

CRN Institute Grads that have recently earned their credentials:

Airese Robinson-Moore, CPC-A from Bear DE

A new testimonial was added to the CRN Instittute site from a student who recently took the CPC exam.

If you have any questions about the CRN Institute courses or you have recently passed a board exam feel free to e-mail me.

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CRN Member Highlight

Eric Sandhusen CPC, CHC

Where are you from?

I recently returned to my ancestral homeland in northern New Jersey.

Family time, especially travel and outings.

Do you have any hobbies?

Golf, piano, writing – I don’t get to do enough of any of these.

What credentials do you hold?

Certified Professional Coder and Certification in Healthcare Compliance.

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

Certainly, the AAPC and the Health Care Compliance Association have been the best. Not only did they provide educational and networking opportunities, but by presenting at AAPC Conferences and writing for Compliance Today, I was able to reach nationwide audiences.

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

By accident – I got a job doing claims follow-up and appeals for a faculty practice in Chicago. I really began to learn it from inside-out, and after a while I started a consulting firm doing appeals and Fair Hearings. As the compliance profession evolved and developed, it became clear that it was time for me to go back to work for faculty practices full-time.

What is your current position?

Director of Reimbursement, HIPAA and Fiscal Compliance for Columbia University Department of Surgery. It barely fits on a business card.

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

Helping to develop and maintain a very active AAPC chapter in Fresno, CA, which gave me a lot of opportunity to teach, mentor, and support coders. I helped organize four annual coding and compliance conferences, which generated enough money for the chapter to create a scholarship program for coders to take the CPC exam and attend the AAPC Conference.

What do you find most exciting about this field?

There is vast opportunity for creative leadership, especially in the area of compliance. There are constantly new developments in education, technology, etc.

What do you find most frustrating?

Since compliance is really a process and rarely a finished work, it gets frustrating that there’s always so much more to do that must get deferred. It’s like playing Whack-a-Mole – just when you get one issue resolved, another pops up.

What do you feel the future holds for this field?

I think it will continue to professionalize, as “this field” becomes several specialized fields: billing, coding, compliance, training. I think that we are beginning to connect the cost and waste involved in medical billing with Public Health issues as we reach the limit of health care resources available.

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

Join the CRN listserv! That and read Volume 3, chapters 4 and 15 of the Medicare Carrier’s Manual. But really, there’s not really a substitute for learning the nuts-and-bolts of medical billing.

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

I’d like to see medical school students and resident physicians receive more training in coding and compliance. Too many of them graduate with little understanding of how to run a practice – or even how to code an encounter. Not only would they provide better support for their staff, it could help them provide better, more efficient healthcare and even enhance their enjoyment of practicing medicine.

Who do you consider a mentor?

I’ve learned so much from so many people, but I don’t think that there’s been one person who really invested in my development in that way (other than my parents).

What is your favorite billing or coding product?

Neurosurgery Coding Alert (for which I am consulting editor). I really try to make sure that there’s something for everyone each month, regardless of whether they are a new or veteran coder.

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

I’ve been a member almost since the beginning. CRN has helped me in more ways than I can describe! The forums are often where I start and finish my search for some regulation or reference; the listserv is a great place to give and take; and there’s even camaraderie among participants, who’ve had a chance to meet up from time to time. It’s great to be a part of this community.

Eric Sandhusen can be reached via e-mail.

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Humor

Funny Signs:

Sign over a gynecologist's office:
"Dr. Jones, at your cervix."

At a military hospital door to endoscopy:
"To expedite your visit, please back in"

On a Plumbers truck:
"We repair what your husband fixed."

On the trucks of a local plumbing company:
"Don't sleep with a drip. Call your plumber."

Pizza shop slogan:
"7 days without pizza makes one weak."

At a tire shop in Milwaukee:
"Invite us to your next blowout."

Door of a plastic surgeon's office:
"Hello. Can we pick your nose?"

At a laundry shop:
"How about we refund your money, send you a new one at no charge, close the store and have the manager shot. Would that be satisfactory?"

At a towing company:
"We don't charge an arm and a leg. We want tows."

On an electrician's truck:
"Let us remove your shorts."

In a non-smoking area:
"If we see smoke, we will assume you are on fire and take appropriate action."

On a maternity room door:
"Push. Push. Push."

At an optometrist's office:
"If you don't see what you're looking for, you've come to the right place."

On a taxidermist's window:
"We really know our stuff."

In a podiatrist's office:
"Time wounds all heels."

On a fence:
"Salesmen welcome! Dog food is expensive."

At a car dealership:
"The best way to get back on your feet... miss car payment."

Outside a muffler shop:
"No appointment necessary we hear you coming."

In a veterinarian's waiting room:
"Be back in 5 minutes. Sit! Stay!"

At the electric company:
"We would be de-lighted if you send in your bill. However, if you don't, you will be."

In a restaurant window:
"Don't stand there and be hungry. Come on in and get fed up."

In the front yard of a funeral home:
"Drive carefully. We'll wait"

At a propane filling station:
"Tank heaven for little grills.

And don't forget the sign at a Chicago radiator shop:
"Best place in town to take a leak

Submit your joke or cartoon here and be entered in a drawing for a free TeleWebinar of your choice!

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Dear Cody

Dear Cody, Have you ever seen the medical abbereviation SCD Sudden Cardiac Arrest and what code would you use? Jackie

Dear Jackie, Sudden Cardiac Arrest is coded 427.5 Cardiac arrest. This is found in the Cardiac dysrhythmias category (427) of ICD-9-CM. It can also be used to code cardiorespiratory arrest.

SCD is the abbreviation for Sudden Cardiac Death not Sudden Cardiac Arrest but it is coded the same if no other reason for the death is documented.

According to Coding Clinic Advice "When the physician records cardiac arrest to indicate an inpatient death, do not assign code 427.5 when the underlying cause or contributing cause of death is known since the Uniform Hospital Discharge Data Set (UHDDS) has a separate item for reporting deaths occurring during an inpatient stay."

You can submit your question to Dear Cody and perhaps you will see advice from Dear Cody in a future newsletter.

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