Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associates!

I hope the last two weeks were wonderful for you all.

We had our first CRN Instant Message Chat on Wednesday October 26th at 2 PM and had a total of 20 people stopped by with an average of 12 on at one time. We discussed what we were working on that day like chart audits, writing reports etc. There was a lot of fun chit chat as well. We have one scheduled for next Wednesday November 9th at 2 PM ET. Mark your calendar and plan on joining us. Keep in mind you do need to be logged in at the discussion board area before logging into the chat.

This past Saturday October 29th, 2005 I attended The Monmouth Ocean County Chapter of the AAPC. It was their first conference in celebration of New Jerseys' Coder's Day - October 30th. What a great turnout they had - almost 100 people. The CRN had a booth and we were demonstrating how the CRN TeleWebinars work and showing how almost every single product listed in the CRN Shoppe is available at a discount. I was also showing some DVDs from the latest review blitz. Expect to see a few new names on the discussion lists as many were excited to find out about our network and all the great resources we have for free.

In this issue we are offering a coupon for $10 off for each ICD-9-CM Mini-Course offered by Medcom. The coupon code is "10offMedCom" and it will be valid until November 18th, 2005. If you want to order the entire series (27 mini courses) we have a coupon for $270 off. The coupon code is "H31J-0G5VF0" and will also be valid until Novmeber 18th, 2005. You just enter the appropriate coupon code at checkout and the discount will be applied.

Thanks for being a member of the CRN! See you in two weeks!

--Laureen = )

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Listserv Lately

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

Two weeks on the list serve, are you kidding, I need my own newsletter. It was so hard to pick the topics for this week's. But, that's a good thing, isn't it?

Let's start off with bleeding polyps. The question that started the week was whether you could bill for a polyp and the melena? Two of our experts suggested that both the 211.3 and the 578.1 be billed. However, another expert explained it was in the wording of the physician. If the polyp was not the cause of the blood, bill both. And who said coding wasn't fun?

What about using the modifier 25 when billing for injections? Should you use it? A lot of conflicting information about this has been going around. One poster found a reference pointing out that when the sole purpose of the visit is the injection, only the injection can be reimbursed. However, if chemotherapy is billed on the same day as a visit, then all the services can be reimbursed. It appears that the final answer lies in how the service was scheduled. If the visit was scheduled, performed and then an injection was administered, use the modifier 25. Otherwise, bill only the injection. I found a great site that might help with this as well. It is: http://www.medicarenhic.com/cal_prov/med_
review/modifier25_0404.htm

The above question came from a new list serve user. Welcome to the CRN and to the list serve. You've found a home with wonderful friends, colleagues and experts (all wrapped up in one).

Another big topic this week was gathering references electronically. One person was looking for a crosswalk; others were looking for electronic CPTs and ICD-9s. Two suggestions, both available at the CRN Shoppe, were Encoder Pro and CodeCorrect. Both excellent tools and great suggestions.

Another topic of interest was a colleague looking for salary rates for a Medicare coder. I think $500,000 is a good start! :-) However, don't take my word for it. Check out salary.com or PAHCOM. Other organizations often have salary surveys. They might be worth a look (AAPC, AHIMA, BAMP, etc.)

Until next time,

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

--Suzan

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The Coding Sleuth

by Tara Conklin, CPC

Greetings from The Coding Sleuth,

It seems our investigations the past few weeks have kept us busy in the 10000 Block of the CPT Neighborhood. This week is no different. While closing the book on last weeks’ case, “The Length of Lesion Coding” I noticed a few shady characters hanging about. I decided to check into them a little further to see if I could make sense of them.

The first one I set my sleuthing mind to turned out to be right in the middle of the lesions we investigated last week, Skin Tags. At first glance they appeared similar to benign lesions but a second look showed they had very different personalities. The first thing I discovered was they pose no real medical threat to a patient. Getting them removed is normally for cosmetic purposes. This was important to keep in mind as I knew there was a possibility an insurance carrier may not cover their expense and could hold the patient liable for the cost. I then turned my attention to their corresponding codes. There are only two to report this service, 11200 & 11201. These codes may be billed regardless of the anatomical location of the skin tags, unlike the lesion codes which are grouped by size and location.

I also found it interesting these same two codes are billed for the removal of skin tags regardless of method. The codes themselves were the real confusion culprits. 11200 is reported for the removal of skin tags “up to and including 15”. That’s pretty self explanatory. Regardless if 1, 3, 5, 12 or 15 were removed, you report 11200 once. It was the add-on code, 11201, I realized was the problem child of this duo. 11201 is reported in addition to 11200 and states “each additional 10”. This was pretty clear cut if a total of 25 skin tags were excised; 11200 for the first 15 and 11201 for the last 10. It was when less than 10 after the first 15 were removed this code tried to give you the slip. The verbage in this code's description did not include the words “up to” like its predecessor did. So what if a total of only 20 skin tags were excised. Do you have to have a “compete additional 10”, can you bill it any way assuming the “up to” words applied and were just inadvertently left out, or does the physician lose the work done in the last five simply because he didn’t have an “additional 10”. I was determined to crack this code.

It turned out to be easier than I expected. The answer I sought was found in an issue of the CPT Assistant published on 12/1/1990. This publication states “If 23 lesions were treated (less than 10 additional lesions after the first 15), the codes 11200 & 11201-52 would be reported (-52 represents reduced services). There it was in black and white and it couldn’t have been more logical. If 11201 is used to report “each additional 10 lesions” then anything less than that would be a reduced service. Append -52 and these two characters aren’t so shady any more.

I then turned my attention to a trio of troublemakers and their name said it all “Destruction”. There were two sets of “Destruction” codes and I found them hanging out in the 17000 block. The large group of 17260-17286 was used to report destruction of malignant lesions and was no trouble to the neighborly coder. It was their smaller counter parts used to report benign or premalignant lesions that were the real troublemakers. Codes 17000-17004 proved to be even more confounding that the Skin Tag Twosome.

The first two of this trio were actually pretty tame. 17000 would be reported for the 1st lesion removed only. This code had an add-on side kick 17003 which, as long as you didn’t miss its' key word “EACH” was also easy enough to understand. Report this code for “EACH” lesion from 2-14. Between these two codes you could bill a total of 14 lesions and would have 14 codes, or 17000 x 1 and 17003 x 13. The real confusion came when I turned my attention to 17004. 17004 is a stand alone code and there is a parenthetical note at the end of this code that states (do not report 17004 in conjunction with 17000-17003). Where did he fit into the equation if 17004 is not an add-on to 17000 or 17003 (did you ever wonder what these guys did to 17002; it’s mysteriously missing….hmmm).

Keeping on track, the code itself is reported if “15 or more lesions” are treated. Is it reported once for each lesion or perhaps if only 15 are treated, what?? Once again I looked in my files for any documentation on this menace. I dug around a little but eventually found my answer. Once again CPT Assistant came through. November 1998 Volume 8 Issue 11 entitled “Review of the 1990 CPT Coding Changes Part 1” unmasked the mystery behind this problem code. This article states “… code 17004 also includes destruction of the first through fourteenth lesions. Code 17004 revisions preclude the stair step coding convention (i.e. one code builds upon the next). For example, for destruction of 20 lesions, code 17004 would be reported once.”

Breaking it down with this information makes these codes less troublesome. 17000 is reported for the 1st lesion when total lesions removed equal no more than 14. Lesions 2-14 (13 actual) are reported with code 17003 one time for EACH of these. When the total numbers of lesions treated in the same session equal 15 or more then you bypass 17000 & 17003 all together and report 17004 ONCE regardless of the number of lesions. From a reimbursement standpoint however, these codes have the ability to cause a different kind of trouble.

Any physician with access to a fee schedule (or this article) can easily figure out that Medicare pays $58.74 for 17000, $10.08 for 17003 & $193.94 for 17004. For a patient with either 1-14 or a total of 15 lesions, the coding and reimbursement of these codes is pretty straight forward. It’s when a patient with more (sometimes a lot more) than the 15 lesion cutoff between 17003 & 17004 that physicians may try to play the “Payment Game”. Let’s say a patient comes in to have 28 lesions treated by cryotheraphy (destructive removal). If they are all taken off in the same session on the same day we have already determined 17004 billed one time, is the appropriate code to report this service. The physician will receive a total payment of $193.94. Here’s where the payment game comes in. He figures out if he treats 15 today, he’ll get the same payment of $193.94. But if he tells the patient to come back another day to have the remaining 13 removed, he can make an additional $179.70 by billing 17000 for the 1st lesion and 17003 for the last 12.

We have to keep in mind, anything a physician orders or performs on a patient and submits for payment, needs to be medically necessary and “IN THE BEST INTEREST OF THE PATIENT”. These destruction codes were set up to treat a specific number of lesions on a given day. Unless there is a justifiable medical reason for not removing all 28 lesions (as in our example) on the same day, by making the patient come back another day simply to fatten their bottom line, the physician is potentially setting themselves up for some unwanted scrutiny. 17004 (perhaps only inadvertently, you be the judge) forces the physician to treat as many lesions as possible or necessary on the same day and provide clear-cut documentation if for some reason it’s not in the “best interest of the patient” to do so. Bottom line with this… (and trust me I’ve had several doctors ask me if they could break up treatments in order to obtain extra reimbursement) be careful with these codes and how you use them. There’s a saying in the medical reimbursement world “Don’t Punish the Patient”. It means you can’t charge for non-medically necessary services or inconvenience the patient simply to obtain a greater reimbursement.

Armed with all this new information these two sets of codes can no longer haunt, confuse or intimidate any coder needing to travel through their neighborhoods. What appeared to be no good hoodlums is really no more than two packs of dogs that have a lot of bark… but no bite. The neighborhood is a little safer for all. See you at the CSI Desk!

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.

What an interesting two weeks it has been. I have received my new CPT book, have you? Have you even ordered it yet? You don't need to start using your new CPT codes until 1/2/06, but you need to update your charge tickets for office and hospital before then, and you need to update your computer systems for all charges, starting 1/1/06. So make sure you get your new manual. And if you want your best discount on ordering your manuals, make sure you go to the CRN Shoppe to order. We offer the highest discount on Ingenix products around, so check it out. You may want to order CPT Changes, an Insiders View as wel, as the AMA explains why the changes were made.

On that subject, Annette Grady, CPC, CPC-H will be speaking on "2006 CPT Changes" for CRN Continuing Education in a TeleWebinar on November 22nd at 2pm. Now, I know it is just before Thanksgiving, but this is important information and given that the AMA is only having their Symposium the week before, we could not get the information out any earlier. With everyone's schedule getting hectic around the holidays, we want to make sure you have enough time to prepare for the upcoming changes. There are a lot of changes in General Surgery with a lot of Laporascopic codes added, but that is just the tip of the iceberg. So, join CRN CE for this terrific TeleWebinar by nationally renown Annette Grady on this timely topic. And, if you cannot attend the live seminar, as always, we are recording it, both the audio and video, which you can purchase and download and experience just like you were there, in person. Be the first of your colleagues to know what is going on, and what is changing by attending CRN CE and Annette Grady for this timely TeleWebinar.

Speaking of timely TeleWebinars, I just gave a presentation on "The New Medicare Appeals Process" as of 1/1/2006 (so many changes as of January 1st). The way and to whom you appeal as of next year is totally revamped for physicians offices. It has already changed for facilities. We have gotten quite a few orders for the recordings from those who missed this dynamic (if I may say so myself ) class. So, if you want to learn about the process, have a great take away handout with the forms you will need, along with the links of where you can get the forms, make sure you go to the CRN Shoppe and select recorded TeleWebinars and order this class for download.

Other classes you can choose from will include Arthroscopy, NCCI and ICD-9 Changes for 2006. Although ICD-9 changes went into effect on 10/1/05, it does not mean you are not having problems, particularly with private payers. This download has lots of handouts for your reference and use.

Our mistake - your opportunity! We botched the recording of Quin Buechner, our local Non Physician Practitioner expert. So we will be doing it again on January 10th, 2006. So be sure not to miss "Coding & Billing Your NPP Services" this time. This is a great seminar, telling you the rules, where to get it in writing and helping you to understand the intricacies.

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". The "TRY ME" special is on the CRN Shoppe. You purchase the "TRY ME" and get the Modifiers class with a credit for another class, to be used now or in the future.

Future TeleWebinars scheduled include Deborah Grider coming back with a blockbuster class on ABNs in the Physician's Office on 11/8. Robin Roach, CMRS has agreed to join us to speak on Marketing for the Independent Biller. I know that we have a lot of billing companies on the CRN and this is a great class. Robin is active with AMBA (American Medical Billing Association) and she is a marketing force to be reckoned with. Whether you are a small or large billing company, you can learn something from Robin in this class. Actually, a medical practice wanting to market their services to increase volume, (in particular out of network, cash, or non-insured services) can learn from what Robin has to teach. This class will be held on 12/15/05 , which is a Thursday, at 2pm . 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 Live Events:

	11/15/05 Modifier$ - It's All About The Money! by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS
	11/22/05 2006 CPT Changes Overview Annette Grady, CPC, CPC-H
	12/7/05 E&M Auditing: The Write Stuff! by Suzan Hvizdash, CPC, CPC-PC
	12/13/05 Seeing Through Diagnostic Radiology by Tara Conklin, CPC
	12/15/05 Marketing For the Independent Medical Biller Robin Roach, CMRS, President Health Data Solutions, Inc.
	1/4/06 Locate Your HEM in Time! A Unique Approach to Understanding E&M Coding by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS
	1/10/06 Coding & Billing Your NPP Services by Quinten A. Buechner, M.S., M.Div., ACS-FP/GI/PEDS, C.P.C. President, ProActive Consultants, LLC
	To Be Announced ABNs in the Physician's office by Deb Grider, CPC, CPC-H, CPC-P, CCS-P, CCP
	To Be Announced Orthopaedic Arthroscopic Surgical Coding Annette Grady, CPC, CPC-H
	TeleWebinar Prepay "TRY ME" Special: You can attend Modifiers; It's All 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! Reg. Price: $278 You Pay: $208.50

Upcoming Speakers - Dates to be set

• 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.

--Barbara

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Institute News

by Pam Biffle, CPC CRN Coach

Student Success Stories

Congratulations Venice Richardson, Assistant to the Director of Operations at West Jersey Anesthesia Associates for completing the 301 Physician Coding Course.

What made you decide to take a course?
I chose to take the course because I realized that I needed to take the board exam. I do some independent consulting projects and know that my clients would feel more confident in someone who was certified.

Why did you pick CRN Institute?
I chose CRN because it was convenient and I could go at my own pace.

Is there anything you would say to someone thinking about taking a course?
I would recommend this course to anyone especially those with time constraints.

Are you planning on sitting for a Board exam? Yes
Which one?
I plan to take the CPC exam in December.

Do you have a CRN Institute Student Success Story to share?

Just drop an e-mail to pam@crn-institute.com. Let us know about your promotions, new jobs and new credentials!

If you need college credit E-mail Laureen about how to enroll at Drexel University even if you don't live anywhere near Philadelphia.

New classes are being formed for January at Christina Healthcare in Delaware. 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.

Most of you are aware that we offer courses in Medical Billing, Physician Coding and Hospital Coding, but were you aware that we also offer courses in Medical Terminology and Anatomy. Let us know what new courses you would like to see the CRN Institute offer.

Our couses come in two packages - Standard and Premium. The standard package allows access for 1 year and has full e-mail support. The Premium Package has unlimited access and in addition to e-mail support has phone support and optional access to the live phone classes. The standard package is priced at $995 and the premium package is priced at $1995. A payment plan is available for $195 down and $100 per month (for standard package) or $200 per month (for premium package. Both packages include your textbook and workbook. Manuals are purchased separately.

--Pam

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CRN Member Highlight

Brenda Beabout, BS, CCS-P

Where are you from?
I currently live in Muncie, Indiana.

What is your favorite activity?
I enjoy spending time with my friends.

Do you have any hobbies?
Cooking, taking surveys online, playing games online, playtime with my two kittens, tending to my son's busy social life.

What credentials do you hold?
CCS-P through AHIMA. I am looking forward to adding to this soon.

What organizations do you belong to and how have they helped your career?
AHIMA-American Health Information Management Association. This is yet another resource that I can turn to when I have questions about what is going on in this field of constant learning and change.

How did you get into the field of medical billing and coding?
I was taking classes at my local college to try to break into the field. One of my instructors was impressed with my ability to learn quickly and perform accurately....so she recommended me for a position and almost nine years later, I am still learning and growing.

What is your current position?
I currently hold the position of Compliance Auditor.

What is one of your accomplishments in this field that you are most proud of?
Obtaining my CCS-P certification. When I took it, I was one of eleven that did. Three of us passed and we all felt a tremendous sense of pride.

What do you find most exciting about this field?
The constant changes in coding and the opportunities to network with other professionals via the list-servs and at seminars.

What do you find most frustrating?
The shades of gray that cause big tension among coding professionals.

What do you feel the future holds for this field?
Tremendous growth in the number of coding professionals along with continued scrutiny by the government.

What would you tell someone just starting out in this field?
Don't give advice without a site to back you up. I was told by a former boss that this is a CYA world and I have found this to be true on numerous occasions.

If there was one thing you could change about this field what would it be?
Stricter guidelines for those who educate and certify those in our field.

Who do you consider a mentor?
My mentors are all the fine people who freely dispense their knowledge and advice on the list-servs. Also, Don Self who helps keep it fun.

What is your favorite billing or coding product?
I refer yearly to CPT Changes and to the CPT Assistant Magazine which are both available through CRN.

What is your affiliation with the CRN and how has that helped you?
I am a member of the list-serv. This is an extremely useful tool. I utilize the answers in my day-to-day work and also enjoy networking with all the great people on it.

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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 just read the letter about coding jobs from home and the availablity, yet I see so many jobs in this field where you can work from home.

What exactly is the scoop and the probability of working in Coding from home?

Thanks,
--TT from NC

Dear TT ,
There are home coding jobs from some companies, but they are reserved for the best and most competent coders.  They do not take new coders as they need to count on the home based coders to deliver accurate results with relative high speed.  They do quality control, and accuracy is a must.  Some of the organizations require you to take a test before you start with them. I have seen some of the tests and they can make a 10-20 year experienced year coder wince with the challenge. The organizations that use home based coders promise their clients that they are using the "crème of the crop" and they make sure that this is true through the hiring process.

As to how to find these companies, it is difficult.  I personally know of two of them and if you feel that you meet the qualifications I laid out above, I would be glad to forward your resume to them.  Email your resume to me at codey@crn-web.com.

To find the other companies I think it is about networking; get the word out there that you are interesting in home based coding and when a job is available, the people needing your services, will contact you.  I personally keep a list of those looking for such positions because clients come to me looking for such people, but again, they cannot be people with little experience.  They must be seasoned coders as described above. Usually, only the best and the brightest coders get to do their work from home.  Interestingly, many of them have full time jobs and do 20 hours a week of home based coding on the side to supplement their 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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