Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associate!

It's been two weeks since our last issue. I took a tumble on Labor Day trying to show off for my friend's 5 year old and was laid up for awhile and could not work on the newsletter in time. I had a lovely 5 hours in the ER, enjoyed crutches for a few days and those attractive compression wraps. But I'm happy to say I am walking crutch free and will not need surgery.

This of course is nothing compared to what people are going through in the areas devestated by huricaine Katrina. Suzan in her column below gives some websites for providing help.

We have made some additions to the CRN since our last newsletter. We now have live chat - similar to instant messaging or a chat room where it is real time text chat back and forth. So the next time you visit the CRN Web Forums see if anyone is in the chat room.

Just as a reminder we do have a forum called "By the Water Cooler" which is designed for off topic discussions not related to medical billing and coding. Because this is web-based people go to it if they want to vs. e-mail which comes to us on a listserv and forces us to delete off topic messages. The Water Cooler is also a great place to share personal stories, or talk about the latest episode of your favorite TV show - just like a real water cooler on the job.

Enjoy your week! --Laureen = )

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Listserv Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

I’m back!! Mickey Mouse and all of his friends told me tell you Hello from the “Happiest Place on Earth.” Now, from the “Second Happiest Place on Earth” comes a summary of last week’s and this week’s activity on the CRN list-serve.

The exam component of an E/M service was a question of substance on the list. We debated what the difference between a detailed and an expanded problem-focused exam would be. It is payer specific. Some payers say that expanded visits are 2-4 body areas/organ systems, while others go with a four by four rule (4 body areas/organ systems with 4 descriptions under each one), and a third shows that at least one (1) of the 2-7 body/areas or organ systems should be more detailed. The bottom line: Ask your payer.

A few other E/M service questions popped up this week as well. HPI vs. ROS can you count elements written in the HPI area in the ROS area. In a nutshell, this example had a lot of elements in the HPI and so therefore, four (4) were counted in HPI and the rest were counted elsewhere (ROS, PFSH, etc.).

Several coding questions were answered, as usual. One was for the code on skin tag removals (11200). Another referred to the reimbursement amounts of co-surgeons. Each surgeon would be reimbursed at 62.5% of the reimbursement amount. What is the venipuncture code that replaced the G-code for Medicare? 36415.

Another big topic this week was the transporting of patients. Can an office do this? Is this a violation of a kickback ruling? Daryl made an excellent post on 8/29/05 detailing this situation. He wrote it at 9:07 pm. Just goes to show you that we never sleep!!.

One topic from last week that was discussed quite a bit (I caught the tail end of this) was the SA modifier. It appears to be a modifier used when a CRNP sees a patient under a collaborative agreement between the CRNP and the MD. It also seems that certain Medicaids are the only ones accepting this modifier. So, check with you local Medicaid before instituting.

Where to go to write a good appeal letter? A poster asked this question and was directed to Appeal Solutions where you can find help and resources for getting that appeal letter just right.

A poster relayed an experience with a seminar that turned out to be a major push for another product. How can you tell whom to trust when deciding where to spend money on seminars? You want to make certain you recognize the name and that the CEUs are from a reputable source (AAPC, AHIMA, etc.) The one place to go to for an immediate response is right here, on the list serve. With all the expert ears and eyes on the list serve, someone is bound to provide you with information about a particular seminar. Many of us speak at these seminars as well.

What about the patient getting a check in the mail for over $8000 and spending it instead of paying the physician to whom the money was due? We’ve all seen similar situations and have dealt with this in many different ways that were expressed on the list serve. You’ll want to check with management and/or your physician before trying them, but they all have worked. Some of these were: to garnish the wages of the patient or policyholder, tell the patients you’ll be contacting the IRS, get your clearinghouse involved, get the insurance company involved, or get the employer involved. So many solutions, all taking determination and time!

And finally, the most important discussion of last week, which is still on our minds this week was the horrific devastation of Hurricane Katrina. Many of our friends, colleagues, and relatives live in this area, and our thoughts and prayers are with every one of them. There are many organizations coordinating donations to be sent to this area of the country. Some are asking for clothing items, some for monetary contributions, and some for volunteer hours. The members of the list serve have such big hearts, and we know everyone will do all they can to help out. But, please keep in mind to make sure your donations and contributions are going to highly reputable organizations. Unfortunately there are entities out there trying to capitalize on others’ misfortune. Never give your credit card out over the phone when you have not initiated the call and never give cash to someone not representing a well-known organization. A few good web sites that we recommend are http://www.redcross.org , http://www.brothersbrother.org, and http://www.salvationarmyusa.org.

Until next time,

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

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.

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:

• Physician Education - Compliance is REAL
• HME or DME Coding & Billing
• 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:

• 9/20/05 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

A new Drexel University group starts the week of September 26th. If you need college credit E-mail Laureen about how to enroll at Drexel University even if you don't live anywhere near Philadelphia.

Our Physician-Based Medical Coding class part 2 resumed 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.

For those working full time in NJ the CRN Institute is forming a consortium where employers can take advantage of a grant program that provides training funds (including books and possibly the board exam fees) to provide their employees added skills. The employer contributes the paid time for the employee to attend the training. For more information and to be put on the interested list E-mail Laureen.

The beta tester discount still continues. You have until September 30th day to take advantage of the September beta tester discount ($800 instead of $1995) for our online coding and billing courses then it goes up by $100 for the month of October. We are able to split the payment into two payments if that would make it easier for you to get started. These are the courses available with the discount:

Medical Billing
Physician Coding
Hospital Coding

CRN Trained - Now Coding Certified!

This weeks CRN graduates that have earned their coding credential:

• Kim Krause, CPC-A ~ Galloway, NJ

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CRN Member Highlight

Belinda Inabinet CPC

What is your name?
Belinda Inabinet, CPC

Where are you from?
Lexington, SC

What is your favorite activity?
Taking teenagers on mission trips

Do you have any hobbies?
Reading, computers

What credentials do you hold?
CPC

What organizations do you belong to and how have they helped your career?
AAPC. Being a member of the Academy has brought me in contact with many experts over the years that helped my career, has taught me how to code PV studies (thanks for Gay Boughton-Barnes). It has opened doors for me to encourage others, become more involved in the coding community (thanks to Janet Dunkerley). I am also the current president (for the 2nd time) of the Capital Coders. This has brought many challenges and rewards to be part of such a great local chapter.

How did you get into the field of medical billing and coding?
I started out as a secretary for a home health agency. Because they were behind in their billing, and I was caught up, I offered to help enter the visits so they could be billed. I eventually took over all the billing for them. I then moved into a cardiologists office nineteen years ago and have been here since that time.

What is your current position?
Technical Support Manager.

What is one of your accomplishments in this field that you are most proud of?
Because of the networking on the local level, I met some people from a competing cardiology group. We were discussing nuclear stress tests. We had been told previously by BCBS, in writing, that procedure code 93015 was included in the primary procedure of 78465. While talking to the other coders, I found they were getting payment from BCBS (their physician was on the BCBS board) for the 93015. After confronting BCBS with this information, they agreed to let us back bill for all the 93015 we had not gotten payment for. This resulted in a huge revenue boost for my practice. It also has brought local chapter meetings involving roundtables of common denial issues for like specialities.

My other accomplishment was contacting our governor and getting a coders day for SC (May 20).

What do you find most exciting about this fIeld?
Nothing ever stays the same. There is a constant challenge, and always something new to learn.

What do you find most frustrating?
Nothing ever stays the same!! Insurance companies have their own bundling programs. There’s no national standard for this.

What do you feel the future holds for this field?
There’s many opportunities for us in the future to show how coding is beneficial. I the future for us as coders is a wide open field to continue to learn and teach. I believe it our responsibility as coders to ensure and to teach our peers and our physicians how they can get the most bang for their buck.

What would you tell someone just starting out in this field?
Two of the most important things for anyone starting out is find a mentor, and learn! A mentor should be a trusted person who you can call on just to vent your frustration at times. Never stop learning. Something new comes along every day and this is an opportunity for you and for me.

The last thing, NETWORK! What a great organization we have in the Academy, as well as the other network of experts (CRN). Everyone is always willing to help.

If there was one thing you could change about this field what would it be?
I think I would change myself. I don’t think I could change the entire system, so it must be me that needs to change and learn to accept change as I do most other things. If the power were available, I’d love to see the same coding edits used between insurance companies.

Who do you consider a mentor?
I have had several mentors, Gay Boughton-Barnes, Linda Gates, Janet Dunkerley on a professional level. On a personal level, it would have to be two gentlemen, Charlton Bozard and Josesh Ratcliffe (both pastors of mine)

What is your favorite billing or coding product?
I love the expert books by Ingenix

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Humor

The 3 Most Dangerous Women in the World

A man was walking on the beach when he came upon a Genie in a bottle. The Genie granted him three wishes. The man said that he would like to spend the night with three of the most dangerous women in the world. The Genie said "okay" and gave him Lorena Bobbitt, Tonya Harding and Hilliary Clinton. ***POOF*** The next morning he woke up and he was castratred, both knee caps were broken and he had no medical insurance. --submitted by Charlene Burgett.

This Issue's Cartoon

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,
I am a recent coding graduate and am finding it hard to break into this profession because I don't have any experience. Do you have any advice? Frustrated in MA.

Dear Frustrated,
This is an age old problem for anyone breaking into a new career. Be willing to start at a lower wage to get in the door and get that precious experience. Be willing to start in a different position than you really want but express your desire to move into coding. The bottom line is be flexible.

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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