Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associate!

Thanks to all who have been e-mailing us with great feedback about the Newsletter. In this issue we are introducing a new column called "Coding Sleuth" where we will be providing articles of interest to the medical billing and coding community. Tara Conklin, CPC will be the main contributor but if you would like to have an article considered please forward to editor@crn-web.com.

We are also happy to announce a new layout for our website. There is a new top header that will stay consistent as you browse through the various areas of the CRN. Check it out at http://www.codingandreimbursement.net. We welcome any and all feedback about the layout of the site.

Last weeks issue was not sent because my father went into the hospital. As some of you know he is the business manager for the CRN Institute and even grades homework! :) It was quite an ordeal as he is a heart transplant patient and we had to find a hospital that could care for his needs. Turns out he has bronchitis and pneumonia. Hopefully he will be home soon!

--Laureen = )

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Listserv Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

This week we tackled some interesting subjects; everything from CCI edits, to allergy billing, to patient dumping. Never ceases to amaze me as to the caliber of experts we have in our community. Everyone wants to do it right. And everyone also wants others to do it right! That’s a real community I’m very happy to a part of!!

The question concerning the dumping of patients involved a pediatric orthopedic practice who was seeing more and more Medicaid Managed Care patients which the other practices in the area didn’t participate. Is it required to follow a patient that you see in the ED even if you don’t participate with the patient’s insurance? The consensus was that the private offices didn’t have to follow these patients. If they didn’t participate with the insurance, they were not required to see them after the ED visit. It seems a bit off balance in this particular area that one practice is seeing the majority of these patients and not getting the others. One poster suggested arranging a meeting of all of the practices to discuss this. Keep us posted!

Discharging from observation: Which code set is best? The question was why was the 99238 denying? When a patient is in observation, the discharge code would be the 99217. If the patient was in and out on one calendar day (not the case of this patient) then the 99234-99236 codes would be the appropriate ones to use.

Then there’s the CCI questions! Chocolate cream pie!! I’ll never look at those frightening charts again in the same way!! But, what a helpful way to look at those columns. The question referred to the relationship Column 1 has with Column 2. If 97112 is in column 1 and 97140 is in column 2, why wouldn’t 97112 be in column 2 when 97140 is in column 1? All these columns-and I’m not even in Greece! The chocolate cream pie explanation was that column one is the pie and column 2 is a piece. The latter is part of the first, but it cannot be reversed. If they were mutually exclusive codes they would then be in each other’s column 2s. Now where’s that pie!!??

Hope you all got what you were looking for this week on the list.

As we begin another busy week, let us all take time for thoughts, prayers, and hopes for the folks in Hurricane Rita’s path.

Until next time,

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

--Suzan

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The Coding Sleuth

by Tara Conklin, CPC

Hello CSI Seekers

It’s not uncommon for physicians to perform minor procedures in the office. Unfortunately many of these physicians potentially lose a great deal of revenue each year because they are not billing for these services correctly. Just because a procedural code falls in the “Surgery” section of the CPT does it require the patient to be in an emergency room or acute care facility in order to bill it. Let’s look at a couple examples. I personally have seen these working with several family and general physicians over the years.

Ms. Ima Careless, an established patient, comes to the office after burning herself cooking in the kitchen. She’s suffered first degree burns to her hand and wrist. Dr. Smith applies burn cream, dresses the wound and prescribes a mild pain killer. He charges 99213 for her visit.

Pretty cut and dry wouldn’t you think? Think again. According to the Medicare Fee schedule Dr. Smith will get paid $51.42 for billing 99213. However, had he billed 16020 for treatment of a small burn he would have received the non-facility payment of $80.13. Ouch. If he treated two similar burns each month for a year and billed them all out with 99213 codes, he will have lost $689.04 in yearly revenue. If this had been a smaller burn of say just a portion of the hand and treated with local treatment only, it would be reported with 16000. 16000 pays out at $68.22 for non-facility care. That’s still $16.80 more than 99213. Also let’s not forget, if his documentation supports an E&M with the decision to perform a burn treatment procedure, the appropriate E&M code can be billed in addition to the procedure code. Since none of the codes from 16000 to 16035 carry a global period this makes them a minor procedure and the E&M would need to be billed with modifier -25.

Other than 16010 & 16015, which are burn treatments under anesthesia, any of these codes may be used and potentially performed in an office setting. Remember, codes that state “under or with anesthesia” are referring to either regional or general anesthesia. A simple local injection is always included in the procedure.

Another example of procedure codes overlooked and often missed are fracture treatments. Not all fractures require surgery, manipulation or even a hard cast in order to be treated effectively. Sometimes because of the location of the injury or lack of severity a simple splint application treats the fracture quite nicely. Let’s say a patient visits their physician, Dr. Smith, after injuring their arm in a fall. Dr. Smith takes a history, examines the arm and sends the patient across the street to get an x-ray. Upon review of the radiological film a hairline fracture is noted in the upper radial head. Dr. Smith proceeds to apply a splint and tells the patient to follow-up in a week.

Now let’s examine this visit from the reimbursement perspective. Dr. Smith, not knowing any better, sees the splinting as a routine part of caring for a simple, uncomplicated fracture of his patient. Due to the extent of his exam he bills 99214 for this visit and he’s happy with his $80.79 payment along with whatever he gets paid for the splint supply. What Dr. Smith doesn’t realize is had he billed 24650- closed treatment of radial head or neck fracture; without manipulation, he would have received the non-facility payment of $232.43 just for the splinting. Double Ouch! But wait, we’re not done. He also performed an E&M with the decision to perform the procedure. He could not have made the decision to treat the fracture with the splint had he not ordered and reviewed the x-ray which showed the fracture to begin with. Taking into account the work involved in performing the fracture treatment and the fact 24650 carries a 90 day global making it a “major” procedure, we’ll code the office visit 99213-57. This is an additional $51.42 for a total reimbursement gain of…$203.06. Dinner and Emeril’s anyone??

These are only a couple examples of common procedures performed in the office that are easily overlooked and not billed by physicians. Debridement, sutures, injections and biopsies are also often missed.

Now you ask, “What can I do?” Your first line of defense is when the patient schedules their visit. Notice what they are coming in for. Could their complaint potentially require a procedure as our fracture and burn patients did? Lastly double check the charge ticket or documentation at the end of the visit to see if any procedures were performed. If you see a procedure was done but not billed, query the physician to find out if he/she wants to bill for the procedures he performed. You might be surprised to find out he/she didn’t realize they could. I worked for a General Surgeon who was missing his post-operative debridements on almost every patient.

In the end, check the documentation, double check your coding rules, and make sure the procedure code matches the actual service performed. The gains could be well worth it.

--Tara

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TeleWebinar Update

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

CRN Continuing Education, Inc.

It is after October 1 st, so I hope you are using your 2006 ICD-9 codes. If you need a new ICD-9 manual for 2006 or want to preorder your 2006 CPT manual you can go to the CRN Shoppe at http://www.CRNShoppe.com to order it. There are also other great products there, including " CPT changes, an Insiders view for 2006". As you bill in October, remember that 2005 ICD-9 are applied to services in September or earlier and 2006 ICD-9 for services for services as of October 1 and later. Isn’t it fun to manage this with your practice management System? If you missed Joann Bakers Telewebinar on 2006 ICD-9 you can still purchase the recording and get a great educational opportunity for a very current topic affecting us all. To do so, go to http://www.CRNShoppe.com/tw .  You can still earn your CEU’s with the recorded version of the TeleWebinars. And remember, with the CRN Continuing Education Telewebinars, the recordings are not just the voice, there is the visual over the web as well.

If you missed Deborah Grider’s TeleWebinar last Tuesday on NCCI, you missed a terrific class. She explained NCCI eloquently and provided some terrific education for the attendees. Using the Webinar feature of CRN Continuing Education, she also demonstrated how the NCCI appears in Ingenix Encoder Pro. We discussed the difference between the subscripts which allow or disallow the override of the edit via modifier, identified the modifiers which do override and gave examples when they are used. It was a great TeleWebinar and you can still purchase it the recording at http://www.CRNShoppe.com/tw and get continuing education, earn your CEU’s and learn something new. I know I did. Thanks, Deb, for a terrific TeleWebinar. 

Things have been very busy around here, so we do not have TeleWebinars planned for this and next week, but watch out, we have some terrific ones scheduled for the middle and end of the month. Annette Grady will be speaking on Orthopaedic Arthorscopic Surgical Coding on 10/19 and then I am speaking on the New Medicare Appeals Process on 10/25. These are must see/listen Tele/Webinars. Do you know that the entire Medicare appeals process is changing on 1/1? Be one of the first to know the new process from moi. We look forward to your sign ups and attendance at these great classes.

We are rescheduling Laureen’s class on Modifiers to 11/15 and offering a SPECIAL! You can attend Modifiers, it’s All About the $ for half price if you sign up for another TeleWebinar. What a great deal, two TeleWebinars for $208.50! That is the cost of most single classes and you will get two. This is a “Try Me” Special.

Future TeleWebinars scheduled include Quin Beuchner, our resident subject matter expert on non-physician practicioners on November 1st. Deborah Grider is coming back with a blockbuster class on ABNs in the Physican’s office on November 8th and Joan Gilhooly on December 6th speaking on the topic of Consults, including all the changes reflected in CPT 2006. We are busy getting other Subject Matter experts for you so that we can continue bringing great TeleWebinars to the Coding and Reimbursement Community.

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:

	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

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 started 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 October 31st to take advantage of the October beta tester discount ($900 instead of $1995) for our online coding and billing courses then it goes up by $100 for the month of November. 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:

• Doreen Connolly, CPC ~ Apollo PA.

--Pam

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CRN Member Highlight

Chris Felthauser, CPC, CPC-H, AAPC, PMCC Instructor, ASC-OH Advisor

Where are you from?
Currently living in Eugene, Oregon.

What is your favorite activity?
Cooking/entertaining.

Do you have any hobbies?
Cooking, whitewater rafting, camping, that sort of stuff.

What credentials do you hold?
CPC and CPC-H Through the AAPC. I am also a PMCC instructor with the AAPC as well. Recently joined Board of Advanced Medical Coding and am an advisor on the Ophthalmology Specialty Board (ACS-OH).

What organizations do you belong to and how have they helped your career?
AAPC of course, Board of Advanced Medical Coding.

How did you get into the field of medical billing and coding?
Purely by accident. I went to school to study theater and was looking for a job when a friend who worked at a hospital told me they were looking for help…so I thought it would be a temporary part time thing and then found out I really like it, so almost 20 years later here I am.

What is your current position?
Coding Consultant/Educator.

What is one of your accomplishments in this field that you are most proud of?
I think the thing that most makes me proud is that one student you get to during the course. Every once in a while, there’s one student you just know is going to be really great, and the look on their face as they are learning, when you can tell that this is going to be more than just a job to them, they want more. That’s my favorite part.

What do you find most exciting about this field?
The constant changes in coding requirements, and can also be the most frustrating.

What do you find most frustrating?
See above :-).

What do you feel the future holds for this field?
Growth. I believe that coding is only going to grow by leaps and bounds. More education as well. I think coders are going to need more than a set of credentials to make them a coder.

What would you tell someone just starting out in this field?
Don’t make it about the credentials; make it about what you can do.

If there was one thing you could change about this field what would it be?
I would make the standards a little higher. I’ve seen too many people who have been credentialed, but can’t seem to answer some of the most basic questions. I think that not only should we have to maintain CEU’s (which I think sometimes are to easy too get), but that we should also have to re-test every five years.

Who do you consider a mentor?
I’m not sure that I have a “mentor”. However, there are a few people out there that I highly respect and think they have made this field a very exciting place to be. One person who made me decide that I wanted to become an instructor was Bill Dacy. After taking one of his courses, I decided that’s something I wanted to do. There are so many people in different fields that I go to for different pieces of advice, Jo Ann Steigerwald, Sue Vicchirrili, Mary Pat Johnson, Barbara Cobuzzi, Margie Vaught, Susan Volgerberger, Marvel Hammer…these are just a few names off the top of my head. There are so many out there that truly excel in this field and I could take a whole page naming names.

What is your favorite billing or coding product?
(We’re trying to link to products available on the CRN Shoppe http://www.crnshoppe.com) I’m not sure I have one. I’m an old-fashioned guy, I like to have my books in front of me. I like the paper.

What is your affiliation with the CRN and how has that helped you?
I joined the CRN listserve a while back, then was absent for a while, then came back on and it has allowed me to network with others in the same field. It is a great sounding board, and even a place to get advice. I have met some great people here and have found this group to be more helpful to me than any newsletter I currently receive (although I really enjoy the newsletters as well).

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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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