Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associate!

Greetings from Utah! I just spent the weekend in Park City Utah at the AAPC's Advisory Board Retreat. We were very busy but did get to enjoy the scenery in beautiful Utah. Tomorrow I fly to Las Vegas for the annual AMBA (American Medical Billing Association) conference where I am presenting and having a booth for the CRN. If you are attending that conference please stop by our booth.

Next month we will have a booth at the Ingenix Essentials conference - also in Las Vegas. We'll be in booth #201. Stop by and see us!

We've added a few more vendors to the CRN Shoppe - Greenbranch Publishing and the American Hospital Association. We have negotiated great rates due to our member volume. Many of the products in the CRN Shoppe are discounted at least 5%. See logos to the right for other vendors you can receive a discount on.

Enjoy your week!

--Laureen = )

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Listserv Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

Boy, another huge week on the list serve! I was off the list for a day and when I read everything getting back, I realized that no one really sleeps; we just rest our eyes for a bit.

The week started with a question concerning coding situations in the ED. Can the ED doc bill for reading x-rays? What about fracture care? Neurovascular testing code used in the ED ? Well, as was the response and consensus, only one read will be reimbursed by most insurance companies. Medicare has defined this as the read that lead to the diagnosis. The fracture care situations are not as easily explained. This gets to be pretty heated pitting the ED docs vs. the Ortho docs. Physicians should bill for the services they provide if they are well documented and, obviously, a billable service. The situation between the ED and the other physicians should be worked out within the hospital setting.

Then the 51 vs. 59 modifier question. This line of question seems to be a common concern as I do see it from time-to-time come on the list. This time we had examples of Bronchoscopies being billed with Mediastinoscopies and Video-Thoracoscopies. What modifier is most appropriate? It seemed the logical answer on this was the -59, if it can easily be determined by the documentation that this was separately identifiable. Otherwise, it would be included in the fee for the other procedure being done.

What about the difference between billing a 90862 and an Evaluation and Management (E/M) code. In the example being questioned, the physicians had wanted to start using the 90862 and the coder wanted some further information. Quin, as always, pulled through for us on this one. He mentioned that the documentation is easier on the 90862, however, the evaluation had to include both the psychological effects as well as the physiological ones regarding the patient’s present therapy.

Lastly, we had a coder looking desperately for her CCS-P results from AHIMA. We all know what is like to wait for results on the many different certification examinations. Taking the test in July and still not having the results, is quite frustrating. We do hope Karen got her results and they were the results she was expecting. Keep us posted! We hope you did well!

Other coding questions were asked including questions concerning CCI, and CEUs. The alphabet soup was in abundance this week. But as always, I do hope you all got your questions answered. If you didn’t try again! Sometimes we miss a question or two as they are coming in.

Until next time,

Joining the list serve: $0
Asking questions on the list serve: $0
Advice received on the list serve: Priceless
Reading your weekly CRN newsletter: $0
The value of reading your weekly CRN newsletter: Priceless

--Suzan

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The Coding Sleuth

by Tara Conklin, CPC

Welcome to the CSI Desk.

Last week Coding Sleuth Investigations uncovered lost revenue when procedures are done at the time of the initial visit. Although we solved that mystery we found this mastermind was keeping busy in more ways than one. I was asked to check into the Case of the Follow-up Foul Play. Many of the procedures in the CPT book carry a global period of at least 10 days and many up to 90. During this time period most patients will return to their treating physician for ongoing care. As a physician or coder you may understand most care related to the procedure is included in the initial payment for that particular procedure and not billable separately. But does this mean that all related care is included? I grabbed my hat and headed for the crime scene..the treating physicians' office.

At first glance things seemed neat, orderly and well maintained, no obvious signs of foul play. The medical charts and financials were meticulous and showed signs of a prospering growing practice. Hmm could this be a case of mistaken identity? Could this practice have been a victim of that famous perpetrator.. Lost Revenue? The first place I looked for clues was in the E&M billing. I pulled a few charts of recent patients. From this standpoint everything was crisp and clean. Most follow-up visits were uneventful and related to the global procedure. I found one patient where the physician had treated them for a minor cold during a follow-up appointment and had appropriately billed a 99213 with modifier -24. ("Nice work doc"). I kept hunting through charts my doubt growing.

That's when I found it, the clue I had been looking for. Recently a 16 year old male patient had come in four weeks into the 90 day global period of a broken ankle fracture. I found the written interpretation of an ankle x-ray exam done during the visit, showing this physician had read the actual film. There was no charge on the patient's record for this exam. The same date also showed the physician put a new sort leg cast on the patient's injury as the old cast was rather dirty and worn. Again..., No charge, only a minimal charge for the casting supplies.

I turned to my on-site crime lab to process the information. The first place I looked was in my CPT manual, in the casting guidelines. These guidelines clearly stated the first cast or splint was included at the time a restorative treatment was performed, i.e., reducing or setting the fracture. However it was in the first sentence of these guidelines I found the incriminating evidence I was looking for. CPT states "The listed procedures apply when the cast application or strapping is a REPLACEMENT PROCEDURE USED DURING OR AFTER THE PERIOD OF FOLLOW-UP CARE OR when the cast application or strapping is an initial service performed without a restorative treatment or procedure to stabilize or protect a fracture, injury or dislocation." There it was in black and white and yet the recast for this 16 year old boy was not billed. I looked up the code quickly and found 29405 would be the correct procedure for this patient's recasting.

Next I turned my attention to the x-ray interpretation. What I found was support for this physician billing the "Professional Component" of the radiological exam in the lack of documentation stating he couldn't. CPT states in the Radiological Guidelines "Subject listing apply when radiological services are performed by OR under the responsible supervision of a physician." Recognize it did not specify a "Radiologist". Also it's documented any procedure in the CPT may be billable by any qualified physician. The most important fact to keep in mind is radiological services are divided into two separate components. The technical component is reported by attaching modifier -TC to the CPT code and billed by whoever OWNS the equipment used to perform the procedure. The professional component is reported by attaching modifier -26 to the CPT and is billed by the physician who provides the "interpretation and report". Our physician clearly read the x-ray, and his written report was in the chart. Upon review I noticed two views of the ankle were done, therefore I deduced CPT code 73600-26 should report this service. I then turned to my fee schedule list and found our physician fell prey to potential lost revenue of $91.13. He was paid nothing for his original billing as he reported this visit with 99024 - Follow up no charge.

Sadly my examination of the crime scene uncovered many more charts where "Lost Revenue" had struck. A post-operative wound debridement, a burn dressing change and a surgical wound needle aspiration were among the victims of this devious perpetrator.

I knew the only way to catch this criminal was to beat him at his own game. He counted on ignorance and lack of education to perpetrate his deeds on unsuspecting victims. I sat down with the physician and his staff and shared with them the cold hard facts. Just because a patient is within a "global period" doesn't mean all care provided during that time is included and not billable. A procedure is a procedure is a procedure and whether it's related to a global procedure or not, unless the CPT manual or coding guidelines say otherwise procedures done during a postoperative period should be billed. E&M many or may not be billable based on the circumstances of the exam, but most procedures are.

One of the most amazing things I have found in my code sleuthing is the number of people involved in the coding and billing of claims that have never actually read the guidelines in the CPT manual. It's the first line of defense in preventing the same crimes from happening to you and your practice. We can't stop these vile criminals like "Lost Revenue" from committing their crimes, but if we take responsible measures to stay educated and work together we can certainly slow them down. Read you're CPT, keep up to date on local and national policies, read your Medicare Carriers Manual and check the CMS website regularly for the latest information. Until next time, happy investigating!

The Coding Sleuth
--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.

We continue to recruit exciting new speakers for the CRN TeleWebinars. I just came from a terrific mid year meeting of the American Academy of Professional Coders National Advisory Board and received speaker commitments from some of the best of the best to join the speaker's panel for CRN Continuing Education TeleWebinars. They are excited to be part of this innovative approach to education and opportunity for CEUs in such a cost effective manner. I will list the speakers that will be joining the CRN CE community below. 

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 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 is be speaking on Orthopaedic Arthroscopic Surgical Coding on 10/19. You only have one week to order this terrific topic and class. Annette is a true expert in this field. This is a "can't miss" class. 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 to these great classes.

Have you heard about the "TRY ME" special that CRN CE is offering? Laureen Jandroep's class on Modifiers has been moved to 11/15 and we are offering this SPECIAL! You can attend Modifiers; it's about the money for half price if you sign up for another TeleWebinar. What a great deal, two TeleWebinars for $208.50 why, that is the cost of most single classes and you will get two. This is a "Try Me" Special. If one of the current scheduled classes are not what you are looking for, you can prepay for a class in the future with this half price "TRY ME". If you want to do this, or have any questions about it, you may email Laureen at Laureen@crn-institute.com

Future TeleWebinars scheduled include Deborah Grider coming back with a blockbuster class on ABNs in the Physician's office on 11/8, Quin Buechner on our resident expert on Non Physician Practioners on November 1st 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
	11/01/05 Coding & Billing Your NPP Services by Quinten A. Buechner, M.S., M.Div., ACS-FP/GI/PEDS, C.P.C. President, ProActive Consultants, LLC

Upcoming Speakers - Dates to be set

• Suzan Hvizdash
• Pam Biffle
• Nancy Reading
• Caral Edelberg
• Terry Leone
• Linda Martien
• Peggy Pugh
• Betty Johnson
• Terrance Johnson
• Brenda Chidester

Interested in becoming a speaker? E-mail me.

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

Join us on CRN CE as we experience the future of coding, compliance, billing and reimbursement education. Go to http://www.CRNShoppe.com/tw to purchase your TeleWebinars. Go to http://www.CRN-CE.com to explore the CRN Continuing Education site. Have a great week!

--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 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

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

Where are you from?
Washington State.

What is your favorite activity?
Camping.

Do you have any hobbies?
Yes - Fishing, sewing, canning, genealogy.

What credentials do you hold?
CPC, CPC-H, CCS-P, PCE, MCS-P, CCP, ACS-OR.

What organizations do you belong to and how have they helped your career?
AAPC - this organization has helped to increase my knowledge and networking with other coders/billers.
BONES - This is an organization for Orthopedic Administrators/Practice Managers and helps with specific orthopedic concerns as it works closely with AAOS.
MGMA/College - This organization helps with understanding credentialing of physicians, benchmarking and other administration information.
Credit Professionals International - this organization helps with understanding small claims courts, bankruptcy, credit application process, Fair Debt collections.
AHIMA.

How did you get into the field of medical billing and coding?
I have worked in the medical field since I was a junior in High School and worked in a nursing home. I had a great aunt that got me interested in nursing and thus I took many anatomy and physiology classes along with other sciences.

What is your current position?
Healthcare Consultant.

What is one of your accomplishments in this field that you are most proud of?
I am most proud with my work with AAPC and their members along with working closing with AAOS and being ask to help in their publications. I also feel bless to know many people and help out other coders.

What do you find most exciting about this field?
Believe it or not the ever changing rules and regulations - I like that it keeps you on your toes. I also love the changes in technology and different ways to do procedures etc.

What do you find most frustrating?
So much misinformation that is out there that keeps re-surfacing and causing offices to not be able to know the 'real' rules.

What do you feel the future holds for this field?
I think there are still more and more avenues that will be open up with working with insurance companies, medical societies along with State and Federal Governments.

What would you tell someone just starting out in this field?
Remember to always be teachable and make sure the information you receive and rely on comes from official sources. Study anatomy and terminology and you will go far. Also try to go out of your 'comfort box' every once in a while you may find new doors opening up. Be willing to help and volunteer when called upon.

If there was one thing you could change about this field what would it be?
The competitiveness that is not productive. That is I wish that we could all work better together (Oh does that sound like the Miss America line of wanting World Peace??) I just feel that everyone has something to offer and by tapping all resources it can make us stronger as a profession.

Who do you consider a mentor?
I have many that I look up to and respect in the field because of their knowledge in different areas such as Stan Szelazek his mind of reimbursement blows me away and then Nancy Maguire for 'stick-to-itness' in being in this field for so long.

What is your favorite billing or coding product?
(We’re trying to link to products available on the CRN Shoppe http://www.crnshoppe.com)
Oh I have so many that I use and give out that they now fill both sides of a typed paper. I like CodeCorrect.com and then the addition of DecisionHealth.com, AAOS.org has many things on their site for free as well as ACOG.org. The Federal Register index, many of the sites that show animated surgeries that you can watch

What is your affiliation with the CRN and how has that helped you?
I think I am still a Gold Member (double check for me.. lol) the networking with so many great people. It has been a great site that ya'll but together that allows coders/billers/etc to come together even though you may be all the way across the country.

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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,
A post op. patient came into the office to have a suture removed from the knee. The doctor injected lidocane to remove the suture. What cpt and dx code would you use for "incision of suture"?--LS from NJ

Dear LS ,
Suture removal not under general anesthesia is not separately billiable as it is part of the post-op global. If this patient is in the post-op global period there is no chargeable service. If this is outside of the post-op global or being performed by another physician then the suture removal would be included in the E&M visit for that day.

The phrase "incision of suture" is simply suture removal so don't let that throw you off.

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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