Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associate!

We're on a roll now with issue #5. I've been getting some pretty nice e-mails this past week from folks enjoying the newsletter. It especially made me smile when several of you said they got issue #1 and #4 but not #2 and 3 and asked for copies to be e-mailed for their files. :)

The only thing I could really use some help with is getting some feedback on the newsletter and the various columns. We really want to build this newsletter on the members concerns and preferences so please take a minute to share your thoughts and suggestions at this page.

Have you noticed the cartoons toward the bottom of each newsletter? We have hired our very own cartoonist! Look for more CRN specific cartoons soon. If you have an idea for a cartoon please share them and you'll be entered in our drawing for a free TeleWebinar of your choice!

--Laureen = )

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Listserv Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

WOW-What a busy week on the list. There were so many great discussions this week. I really had a hard time writing about them.

What codes do you use for a well woman exam? An office was having a battle and came to the list for resolution. The code recommended was the V72.31. Who won the battle at work? Do we get any spoils?

Multiple injections and procedures was another big topic this week. The question came from Illinois. If you are billing injections (64470-64476, 64612-64614, and 64622-64627, what modifiers do you use and how should the claim look? It appeared that the injections were being done on different sides, different sites, etc. of the spine. Do you use –51, -50, -59, -RT, or –LT? The possibilities were overwhelming. An answer came back in the form of an example showing that you would use the RT and LT when appropriate and the also use the –59 modifier illustrating that these were different procedures/different areas. Depending on your carrier, another example could be to use the –50 modifier if doing the injections on both sides of the spine. This certainly would be a perplexing situation. But, as we always say, each carrier/payer has their own quirks, and asking them is usually a prudent thing to do.

What about alcohol use, intoxication, alcoholism. How does one navigate the ICD-9 listings? The doctor listed “acute alcohol intoxication, 14 year with first alcohol experience.” The section of the ICD-9 book that would classify this is the 303.0x and the 305.0x categories. But, would this be intoxication, alcoholism, substance abuse, etc. A nice debate resulted and I’m hoping the coder was able to find the best code set. I know I certainly learned a lot about this section of the book just by reading the discussion.

I asked a question from one of our coders as to how to bill for a visit, along with a vaccine, a lab, and a venipuncture. For the most part, all were in agreement that modifiers were not needed. The services were billable as is with the additional code for administration of the vaccine. Again, some payers may not pay everything, but it seemed few and far between.

What happens when a physician orders AND performs an x-ray? What can be counted in the Medical Decision-Making? The consensus on this was that he could include that he ordered the test into his E/M service. But, if he were billing for the full x-ray (technical and professional) he wouldn’t be able to add the points in MDM for the independent visualization.

What happens when a patient is brought in for an MRI, but isn’t able to continue because of anxiety? Responses included that the procedure should be billed with the –53 modifier.

Like I said, we were certainly busy this week. The amount of work that we were able to accomplish because of all the fantastic help from the list serve must have been phenomenal! We all deserve a vacation-oh, sorry, I just came back!!!

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.

2 week countdown to the implementation of 2006 ICD-9.  I confirmed that United Healthcare as a private payer is implementing 2006 ICD-9 on 10/1/05 to be HIPAA compliant.  The question remains as to whether your other private payers are also going to be on board with 2006 ICD-9 on 10/1/05?  I would assume so, get your codes updated and submit HIPAA compliant code sets including 2005 CPT and 2006 ICD-9 as of October 1. 

If a payer does not accept 2006 ICD-9, I would recommend filing a complaint with CMS, since they do not know who is not following HIPAA rules unless they get complaints.  File complaints to CMS at this link .  The AMA has a complaint form related to code sets at this link.  Make sure you update your superbills, charge tickets or routing slips.  Update your computers and educate your practice. 

CRN Continuing Education holds a TeleWebinar today, Tuesday September 20, 2005 at 2 PM EST. If  you missed it, you can order the recording at here. 

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. 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 check it out.

Upcoming Topics:

	9/20/05 Time For Change: ICD-9-CM 2006 Joann Baker, CCS, CPC-H, CPC, CHCC Call 609-965-9585 to get in last minute!
	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.

--Barbara

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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 Delaware 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 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

--Pam

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CRN Member Highlight

Rhonda Buckholtz, CPC

Where are you from?
Seneca, Pennsylvania.

What is your favorite activity?
Horseback riding.

Do you have any hobbies?
Reading, jewelry making.

What credentials do you hold?
CPC.

What organizations do you belong to and how have they helped your career?
AAPC-Made me what I am today! I also now get the pleasure of teaching and helping other practices.

How did you get into the field of medical billing and coding?
I took a filing job in a medical practice because I needed a break from what I was doing and worked my way up from there. I fell in love with healthcare.

What is your current position?
I am the administrator of a 5 physician multi specialty group.

What is one of your accomplishments in this field that you are most proud of?
Seeing my students obtain their certification and eagerness for coding.

What do you find most exciting about this field?
It is constantly changing so I never get bored.

What do you find most frustrating?
It is constantly changing.

What do you feel the future holds for this field?
The future is unlimited in my opinion. Without our help and knowledge most physicians won’t be able to make it any longer.

What would you tell someone just starting out in this field?
Patience and don’t ever stop learning.

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

Who do you consider a mentor?
Barbara Cobuzzi, Stan Szelazek.

What is your favorite billing or coding product?
Code Correct.

What is your affiliation with the CRN and how has that helped you?
I am a member of CRN and the networking is priceless, and the shared resources have helped me out in many situations.

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Humor

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 have been certified for a year now and trying to start part-time coding at home. It has been very difficult to get started. What do you suggest? --NH

Dear NH ,
There are not a lot of coding from home jobs around and there are definitely a larger supply of people looking for coding from home job than jobs.  However, don’t give up.  You indicate that you received your certification a year ago, but you do not indicate how much coding experience you have.  In order to get home based coding jobs you need to have demonstrated experience, beyond classroom training.  If you do not have an experience heavy resume you need to get out there and get experience.  It becomes a catch-22, because some organizations won’t hire you unless you have experience and you can’t get experience unless they hire you.  One way to get experience is to volunteer to work within an organization.  The best way to learn coding is to form a mentor relationship where you code and your mentor reviews your work and gives you feedback.  The best way to get coding experience is through the feedback of a mentor relationship.  So, do anything to get your experience, mentors, and watch for home based jobs.

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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