Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associates!

It's been a pretty uneventful few weeks at the CRN. We are starting to get ready for the AAPC conference in April as we will be exhibiting and speaking. We hope those that are going to conference will stop by the CRN booth to say hello!

We're still working on our new newsletter delivery system so you should get an e-mail in the next week - so be on the look out as you will need to "reply" to that e-mail to continue to receive the newsletters. Such are the pains that e-mail spammers have caused us.

Until next time!

--Laureen = )

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by Suzan Hvizdash, CPC, CPC-EMS CRN Senior Auditor, Instructor

Well, I was wondering if everyone was suffering from the winter-blues and not wanting to talk much. The list was a bit quite last week. I guess everyone has been with me and decorating their houses with Steelers’s Black and Gold!!!

I think there was a brief conversation concerning… CONSULTATIONS!! Okay, I’m just kidding. There was a lot of talk on consultations. There are new guidelines that were recently made available by CMS. Barbara posted the link http://www.cms.hhs.gov/MedlearnMattersArticles/
downloads/MM4215.pdf. Also there was a lot of debate about when is a visit a transfer of care as opposed to a consult. Can this happen after the initial consult? Should it happen at the time of the request or after the specialist sees the patient. This has been extremely interesting and very informative. This discussion is still fairly strong even into this week.

Another big topic-Medicare Stops the 4.4 Percent Payment Decrease!! This is great news. They also announced they will be going back and reprocessing all the claims thus far this year. The list serve was certainly on top of this one!!!!!

Is anyone having trouble with the new CMS website? We’ll if it helps, you are not alone. You think you found your old links and they’ve been changed. You try to use one of your old bookmarks and it’s not available. How about trying to use one of CMS’s links and not getting to where you need to be. These are all problems folks on the list have experienced. What’s nice is that when someone solves one of these problems, they let all of us know. What a help!!!!

Some of the listers are starting to gather their CEUs for their AAPC renewals. If you need a few more, we have recorded Webinars as well as a few live ones in the works. Check out Barbara’s column for more information on that. If you rely on the AAPC quizzes, one lister explained that they are now counted for full credit. Great news!

Other topics included listers needing information about Septoplasty, IDTF, Podophyllum, and many other coding dilemmas. As I always say-these are the experts to come to. There were actually questions AND quick answers on Dental coding (using codes 41899, 23.70, 23.19, 23.01, etc). A lister asked about modifiers for ophthalmology-use RT and LT.

Until next time,

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

--Suzan

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The Coding Sleuth

by Tara Conklin, CPC

The door to my office flew open and there she stood her hair in complete disarray and a desperate look on her face. I put my pencil down; I’d seen the same look too many times before it was nothing new. “Diagnosis Problems” I asked. Her shoulders dropped and she simply nodded. “These neoplasm codes are just driving me crazy. I don’t know when to code primary when they have secondary and what if cancer is unconfirmed. It’s all just so very confusing. Please help.”

I cleaned off a chair that was covered in papers and offered her a seat “Coffee?”

“Please” she plopped down.

I went to the filing cabinet, pulled out a file labeled “Neoplasms” and returned to my desk. Shoving aside reports, today’s paper, my copy of “Pirates of the Caribbean” DVD, and my ICD-9, I flipped through the file and began to explain.

The first thing to understand with neoplasm codes is they are categorized to the location of the pathology, not the actual cell type of cancer itself. For example if the patient has a Small Cell cancer that started in the lungs but has moved to the liver, you wouldn’t code treatment of the liver as “primary lung cancer”. It may be the type of cancer you’re treating but it’s the site that matters. Some Chemotherapy medications are designed to treat cancers in particular organs so the code applied should be designated to the actual location of the disease being currently treated. Physicians and clinicians have a tendency to look at neoplasm coding from the pathological standpoint and want to pick the code based on the actual type of cancer they are treating.

Once we establish the location of the cancer we need to determine what kind of cancer we are dealing with. I’m not talking about the specific name of the cancer like those found in the Morphology codes in the back of the ICD-9. Those are not used for outpatient or physician claims. They are only used by hospitals and other facilities. What I’m talking about is the cancers’ relation to the particular site it occupies. Did it start there or did it decide it didn’t like the neighborhood so it packed up its bags and moved somewhere else. Or perhaps it thinks it Donald Trump and is setting up shop in several locations, pulling a type of Monopoly, (I never did get my shot at Park Place). Regardless of whether or not the cancer is a homebody, a nomad or Donald Trump establishing its “personality” is the first step.

Looking at the neoplasm table in the ICD-9 (which got a whole lot smaller this year) we see the codes are categorized by “primary, secondary, ca in situ, benign, uncertain behavior or unspecified.” We’ll consider these the “multiple personalities of neoplasm.”

Let’s say neoplasms are a kin to pirates, the first two types of neoplasm are malignant or cancerous so they resemble our rouge outlaw pirates. Primary neoplasm is the place it originally showed up in kind of like its Home Port. Some cancers choose to occupy more than one location and will set up show

in several other ports. These additional ports of call are our secondary neoplasm, commonly referred to as “metastatic”. Even if the pirates at home port are defeated, if they still have rouge associates at any of these additional locations, these are still considered “secondary” and should be classified as such. Now Ca in situ or carcinoma in situ (site being a Latin phrase meaning “in place”) is a different problem. This is not really cancer or a full blown outlaw just yet. It may sound like it but it is considered a pre-cancerous problem. It’s like someone who dresses like a pirate, and talks like a pirate and acts like a pirate, but hasn’t joined the ranks of pirates just yet. Also, like the meaning of “situ” states, hasn’t gone anywhere yet. It’s just staying put in one place.

Now believe it or not, not all pirates were bad. Some were actually hired by the governments to go after the outlaw pirates and steel back from them the treasures they took. These were the Buccaneers and although scary and ferocious in their own right were actually pretty harmless to the average law abiding citizens. It’s safe to say they were “benign”. This is exactly what benign neoplasm’s are like. They look scary but don’t offer any real threat.

The last two pose a problem for coders. Neoplasms with “uncertain behaviors” are when at the time of coding, the physician is just not sure exactly what he is dealing with. He needs to take our pirate to the pub (pathology) and give him a few drinks so to speak, see if he can get him to talk. Only when a neoplasm has been clearly identified as either cancerous or benign should it be classified to one of the first four categories. Unspecified is the biggest problem, because that’s when our good doctor simply isn’t telling us what kind of pirate we’re dealing with. We don’t know if he should be hunted down for crimes or just kicked out of town for scaring us to death. When dealing with a lesion excision or biopsy, clarification from the doctor should always be obtained before coding the service. If the type of neoplasm is not clear at the time of biopsy or excision you should always hold the ticket before coding to make sure you not only have the right diagnosis, but can also append the correct procedure code. As we known lesion removal codes are categorized by benign or malignant; much like our pirates. If the documentation only offers the specific name of the neoplasm and you are not sure which code to classify it to, the morphology codes in the back of the ICD-9 offer an easy way to figure it out. For example if the report states “Basiloid Carcinoma” and nothing else. In the alphabetic index under “carcinoma” we find “basaloid” listed as M8123/3. Turning to our Appendix A: Morphology listing, we notice the codes are in numerical order. Looking down we find the code listed under M809-811 Basal cell neoplasm. The part before the (/) is only the classification code, it’s the number after the (/) we want to concern ourselves with. In the beginning of this appendix definitions to this last number are provided with 0=benign, 1-uncertain whether benign or malignant borderline malignancy, 2-carcinoma in situ, 3-malignant primary, 6-malignant metastatic or secondary, 9-malignant uncertain whether primary or metastatic site. With this information we can quickly deduce that the 3 in our Basaloid Carcinoma classified it as a primary malignant cancer. We wouldn’t use this code on our physicians’ claim but it’s a helpful tool to gleam the information we need.

So now we have a good understanding of what the different types of neoplasm mean how do we know which one to use for each service? If you remember your coding rules, you should remember that the primary diagnosis should always reflect the service provided or the reason for the visit.

Let’s say we have a patient with primary liver cancer which has migrated to the lungs. Today’s visit is focused on treating the lung cancer. Since the treatment, medication and work involved is geared toward the lung cancer the code for secondary neoplasm of the lung 197.0 should be our primary diagnosis. Primary liver neoplasm could be used as secondary along with any manifestations of the cancer.

If our treatment is for agranulocytosis or a decrease in white blood cells associated with neoplasm and chemotherapy treatments, our primary diagnosis would be 288.0 followed by the appropriate neoplasm code. The rule of thumb in all coding is to code to the reason for the visit.

Two last things to remember with neoplasm; in your neoplasm table you will see several codes listed with asterisks (*) next to them. The guidelines at the beginning of the neoplasm table state “sites marked with the sign * should be classified to malignant neoplasm of skin or these sites if the variety of neoplasm is a squamous cell carcinoma or an epidermoid carcinoma, and to benign neoplasm of skin of these sites if the variety of neoplasm is a papilloma.

Lastly, the term “mass” is not synonymous with neoplasm, as it is often used to describe cysts and thickenings such as those occurring with hematoma or infection. When you see the term “mass” don’t assume it’s a neoplasm, report it with the most specific code available specific to that particular body site, or wait for any pathology reports first. The term “mass” is more of a symptom than an actual disease or disorder.

Armed with the right information neoplasm coding is as harmless as Mickey Mouse on the high seas. What’s difficult is trying to figure out who’s better looking as a pirate Johnny Depp or Orlando Bloom… popcorn anyone?

--Tara

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TeleWebinar Update

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

This week is very exciting. Suzan Hvizdash taught her Telewebinar, Auditor Training Workshop: Learn How to Educate Physicians, Their Staff and Your Peers this coming Wednesday, February 8th at 2:00pm. We have our largest response so far and we are very excited with the large enrollment that Suzan has received. It must be because the word got out how good her first Telewebinar was, "E&M Auditing, the Write Stuff". (which is still available in a recorded MiniCourse format).

We have some terrific Mini Courses recorded for you to purchase and use for your continuing education, CEU’s as your certification comes up for renewal and for compliance education within your facility. : First, our own Coding Sleuth, Tara Conklin, CPC taught Diagnostic Radiology. Her course called "Seeing Through Diagnostic Radiology" was a terrific class. As you can see from her articles, Tara is a very knowledgeable coder with her own brand of wit brought to the teaching of the potential we can find in our practices. Feedback told us that there is a demand for this topic, so I hope those of you who are looking for this specialty to be covered can make it on the call. If you missed signing up for this class live, you can always get the MiniCourse recorded, via download or CD-ROM. Quin Buechner re-recorded his class, "Coding & Billing your Non Physician Practitioner Services” and it is now available as a recorded MiniCourse.

And we have an unexpected surprise. Laureen Jandroep has recorded her now very famous MiniCourse, "Modifiers – It’s All About the Money” for us. This was not scheduled, but she decided to provide this on the CRN Continuing Education site for those who have not yet seen it. Why is this class famous?. For those not there, the first time Laureen taught this class at the AAPC National Conference in Las Vegas, she had over 600 attendees in one session. And since that conference, this class has continued to be extremely popular. And along with the MiniClass comes a very useful Modifiers Tool.

January 1st is upon us and the new Medicare Appeals Process will be implemented for Physicians practices as of the new year. You can still purchase the recording of the TeleWebinar, "The New Medicare Appeals Process as of 1/1/2006” (so many changes as of January 1st). You don’t want to miss this boat, because one of the changes is a modification to the time period in which you have to appeal and to whom you appeal and when you can add information to the appeals process. Not knowing this critical information can cost you reimbursement which could be due you had you known the process!

We are working on other terrific classes for Neurology, Fee Schedule Establishment, Compliance, Otolaryngology, Orthopaedics, Neurosurgery, and many other terrific topics. Email me at b.cobuzzi@att.net if you have any particular topics that you would like covered. Remember that you can purchase any of these classes recorded if you cannot attend them live.

Bookmark this link to our calendar of events . We have commitments from many speakers and we are excited as the calendar fills up. Get the word out to your colleagues about this great opportunity for education that can be used for compliance and CEU’s. We provide CEU’s from the AAPC and AMBA. We will be getting approval soon to provide CEU’s from HCR (Healthcare Compliance Resources). Stay tuned, this is just getting bigger and better and we are very excited to be bringing it to you.

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:

To Be Announced Orthopaedic Arthroscopic Surgical Coding Annette Grady, CPC, CPC-H

Upcoming Speakers - Dates to be set

• Marvel Hammer
• Frank Cohen
• Pam Biffle
• Nancy Reading
• Caral Edelberg
• Terry Leone
• Linda Martien
• Peggy Pugh
• 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 2 weeks until we chat again! 

--Barbara

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Institute News

by Pam Biffle, CPC CRN Coach

CRN Institute News

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 or anything else you would like to share!

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 start in April.

Classes are also held 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 self-study courses in Pathophysiology and Pharmacology for only $199.00 each. Check back as we announce new courses now under development. Let us know what new courses you would like to see the CRN Institute offer.

Don’t forget we offer payment plans $195.00 down and $100.00 a month.

Student Success Stories

CONGRATULATIONS to Caroline Elliott of Sequoyah Memorial Hospital where she is a Medical Coder - ER/OP for completing the 301 Medical Coding for Physicians course

What made you decide to take a course? CRN meet all the requirements for preparation to sit for the AAPCs CPC exam.

Why did you pick CRN Institute? I search the internet for the continuing education that I needed to pass the CPC exam and CRN Institute met all of the requirements.

What did you like best about the course? Being able to work through the course at my own pace and around my schedule. All of the staff at CRN have been very informative through the complete course. Any time that I had a problem or question I was able to receive a quick response.

Is there anything you would say to someone thinking about taking a course? Yes, I have highly recommended the course to coworker thinking of entering the coding field.

Do you currently have any coding/medical credentials? No

Are you planning on sitting for a Board exam? Caroline is planning on sitting for the CPC Board exam in June of this year.

Any other comments? I look forward to obtaining my credentials and I have CRN to thank.

CONGRATULATIONS to Irene Nugent a Referral Specialist for both Stanford Hospital & Clinics and Lucile Packard Children’s Hospital in Palo Alto, California for completing both the Anatomy and the Terminology Courses. Irene is now enrolled in the 301 Physician Coding course.

What made you decide to take a course? As part of her job Irene enters insurance authorizations into the hospital systems for both inpatient and outpatient services, it was this part of the job that got her interested in finding out more about coding.

Why did you pick CRN Institute? My friend, Michele Midkiff, recommended CRN Institute. She took your course and is now a coder for Interventional Radiology at Stanford. When I looked at your programs, I thought the Medical Terminology and Anatomy classes would be a great review. The coding course will enhance my current job and also open up possibilities in the future.

What did you like best about the course? I appreciate being able to work at my own pace.

Is there anything you would say to someone thinking about taking a course? I would recommend the CRN courses to anyone asking me about it – in fact I already have.

Do you currently have any coding/medical credentials? I received my results back today and my new title is Shaketa L. Bennett, CPC. Thanks to all of CRN Institute Staff, I really appreciate all the help in making that title possible.

Are you planning on sitting for a Board exam? Irene is planning on taking the CPC exam sometime in 2006.

Until next time...

--Pam

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CRN Member Highlight

Amanda Kunze, CPC, OCS

Where are you from?
Wenatchee, Washington

What is your favorite activity?
Doing things with my family! 5 ½ yr old Camree, 3 month old Annie and my husband.

Do you have any hobbies?
I love to scrapbook and cross stitch.

What credentials do you hold?
CPC and OCS.

What organizations do you belong to and how have they helped your career?
AAPC (The Academy), The Coding Institute Discussion groups, and The CRN Group. Daily I read others questions and answers and I am amazed at the knowledge I now have thanks to many of the people on the discussion boards. I also attend an ENT and Ophth. Seminar yearly, which has helped either assure me that I am doing things correctly or helps me find ways that we need to correct things or do things better here at the Eye & Ear Clinic. I am also thankful for the nursing staff and physicians I work with and for. They have been very helpful with answering questions when it comes to the medical end of the coding!

How did you get into the field of medical billing and coding?
I started working at the Eye & Ear Clinic 10 yrs ago as a Receptionist, moved to the Billing Department and worked their until I had my 1 st child, and then when I came back from maternity leave I decided I needed a change and challenge. My now position was open and they were willing to give me a try and allowed me to go to the necessary training and here I am still after 5 years and love it.

What is your current position?
Reimbursement Specialist.

What is one of your accomplishments in this field that you are most proud of?
I’m proud of myself for the fact that I was able to go from very little knowledge to the knowledge I now have about these two specialties and that I was able to pass my CPC Exam and OCS Exam on my 1st try.

What do you find most exciting about this field?
That there is always something new to learn and the fact that things can change yearly. I enjoy sending out an appeal and letter to an insurance company and weeks later finding out that I won and the money is on it’s way.

What do you find most frustrating?
Dealing with the insurance companies and the games that they tend to play!

What do you feel the future holds for this field?
It’s great to see the coding field growing and the need for us. With the changes and the importance of correct coding I think there will continue to be more need for those certified.

What would you tell someone just starting out in this field?
I think it’s a great career to be in especially if you like to investigate, gather information and report back to those you work with!

If there was one thing you could change about this field what would it be?
That the people you work with at the insurance end of it were also certified and understood more about where we are coming from vs. the insurance companies rules.

Who do you consider a mentor?
When it comes to work I don’t know if I can just name one because there are so many that have played a significant role in the knowledge that I have and respect that I have for this job.

What is your favorite billing or coding product?
I use my Coding Companions all the time!

What is your affiliation with the CRN and how has that helped you?
I’ve used the CRN Discussion group from the very beginning of my coding career and the members of the group have been so helpful answering my questions no matter how simple or complex they were. I’ve learned a lot from them and today follow and keep on file a lot of what I’ve read from the group.

How can other members reach you?:
My name is Amanda Kunze and I work at the Eye & Ear Clinic in Wenatchee , Washington. My phone number is 509-662-7143 and my email is Akunze@wenatcheeeyeear.com

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Humor

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