Coding & Reimbursement Network News

From the Founder

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

Hello CRN Associates!

Well, we finally got our new newsletter delivery system put in place. You should have received an opt-in e-mail by now. If you are reading the newsletter on the web and you want to receive a personal copy delivered to your in-box please sign up here. Look for a confirmation e-mail you need to reply to and you will be all set.

A little more than two weeks to go until the AAPC conference. Many of your favorite CRN characters will be there, Barbara, Suzan, Pam, and myself. Come visit us at the CRN booth and see our new brochure!

Barbara has been hard at work securing great topics for our CEU mini-courses - be sure to check out her column below.

Until next time!

--Laureen = )

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by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

Topics! Topics! And more topics! There were a lot of discussions taking place on the list over the past few weeks. Coding questions from vaginal dilation to neonatal billing, to allergy prep drops, as well as a diagnosis debate were asked and answered!

A lister had asked for references regarding Pain Management and got several sites to reference such as www.nlm.nih.gov, www.guidelines.gov, and www.uptodate.com. I hope they were all helpful!

A few of the bigger debates dealt with HPI elements and billing under an individual billing number as opposed to a group number.

The HPI debate started when a lister asked us to pull out the HPI elements of her example. Several chimed in with their thoughts. The original question dealt with using the elements more than once. That isn’t an option and didn’t need to be considered in this example once a few offered their opinions. Then the debate over using negative symptoms as signs/symptoms came up. One lister referenced an AMA source that stated this cannot be done and then another lister offered a reference on where to find the explanations of each of the HPI elements. It was a productive discussion and I hope everyone took a lot away from it. I know I did.

The next big discussion dealt with the billing numbers of a practice. Can you bill group services under individual numbers? Do you have to have a group number? What about the situation with a PA? Does that change the billing numbers? What about when we begin using NPIs. It was suggested that the lister ask a tax attorney what the best way to approach this might be. Others remarked that it isn’t a requirement to bill under a group as each physician may make his/her own decision regarding participation with the insurances/Medicare. The thread is definitely worth reviewing. This thread could be read at http://health.groups.yahoo.com/group/CRN-L/message/51912?threaded=1 and http://health.groups.yahoo.com/group/CRN-L/message/51857?threaded=1.

Very noteworthy!

A little over three weeks until the AAPC Nation Conference, “The Spirit of Coding” in St. Louis starts April 2-5, 2006!

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

Until next time,

--Suzan

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The Coding Sleuth

by Tara Conklin, CPC

There is a vile criminal on the streets that you may be an unaware victim of. This criminal is cunning, patient, and deadly at epic proportions. The worst thing about this mastermind fiend is so many people are focused on some of his lesser partners in crime, by the time he strikes many people it’s too late to save them. He’s unbiased in his crimes. He attacks people of every race, creed, sex, and color and is the number one killer of women in the United States.

With these statistics, what comes to mind... cancer perhaps… maybe even breast cancer, but you would be wrong. His name is Coronary Artery Disease and he lies in wait for any person willing to give him a key to the front door of their heart. All it takes is a bad diet, an inactive lifestyle and in some, a genetic trait. Unfortunately the latter is not a prerequisite to giving him access to your life; it only helps him along a little bit.

Sure, you’ve heard of him. You know his methods and exactly how he works. The best thing you can do is learn how to protect yourself. Eat sensibly, exercise and for heaven's sake, put down those stinkin’ twinkies and that double latte with extra cream!

But we’re not here to lecture you on CAD (how fitting for a name, don’t you think? The definition of CAD is “one whose behavior is unprincipled or dishonorable.”) but to help thwart that all too familiar cohort of his…. Unpaid Claim; UC for Ugly Criminal is better suited, I think.

There are so many codes in the ICD-9 to use for this disease it’s easy to get used to one or maybe two codes that are utilized as “trump codes”. If we look under the surface there is much more to them and if we get a clear understanding of these codes we can confidently thwart UC. Let’s put on our sleuthing hats and see what we have.

Most of the codes we are dealing with are found in the 414 section of our ICD-9. A little education and help from our documenting physicians helps the coder narrow this list of codes down to something specific to each patient. This is how they look:

414.00 -	Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01 -	Coronary atherosclerosis of native coronary artery
414.02 -	Coronary atherosclerosis of autologous vein bypass graft
414.03 -	Coronary atherosclerosis of nonautologous biological bypass graft
414.04 -	Coronary atherosclerosis of artery bypass graft
414.05 -	Coronary atherosclerosis of unspecified type of bypass graft
414.06 -	Coronary atherosclerosis, of native coronary artery of transplanted heart
414.07 -	Coronary atherosclerosis, of bypass graft (artery) (vein) of transplanted heart

Pretty impressive, huh? But don’t be alarmed; we’ll look at each one.

The first one is probably the one you are most familiar with because it’s unspecified. Admit it, how often does your doctor actually tell you which type of vessel in the heart is effected. However as coders we are allowed a little leeway with figuring out the best code on our own. WHAT?! You say, we can think for ourselves without the doctor’s documentation?!

Yes, you can… at least in this circumstance. Let’s say the physician doesn’t document the patient’s natural or native coronary artery is effected, but you notice that the patient does not have a history of having had a previous bypass procedure (in the heart, of course). You, as the coder, can actually be the coding sleuth and make the determination based on your exemplary skills of deduction that the effected artery MUST be native. How can it possibly be anything else. So you can code it to 414.01 all on your own. How do you like them apples??

Now, with the next codes it’s not so simple. If the record shows a history of previous bypass and CAD is present, no assumptions can be made here. You have to look at any available documentation such as a recent heart cath (remember Dr. Stan Osis. He was such a nice guy and his claims and payments look much better, I hear). Keeping on the subject, these next codes deal with people who have had bypass graft. Knowing what type of graft they have is a key factor in making the correct coding choice. Remember these codes deal with the vessel affected by CAD. 414.02 is used for CAD in a bypass graft made of the patient’s own vein, commonly the saphenous vein from their leg. 414.03 is used for grafts from somewhere else, sometimes man-made or from a cadaver. Some grafts are made from arteries instead of veins. The most common arteries used for coronary bypass grafting are the patient’s internal mammaries; either the left or right. These are referred to as LIMA or RIMA for short and when affected by CAD are coded with 414.04. 414.05 is used when the documentation shows CAD of a bypass graft but not specifically which one.

The last two are used when the patient has had a previous heart transplant and now has CAD in the coronary vessels of the transplant; 414.06 if the vessels are native… no history of CABG here, and 414.07 if the transplant has also been previously bypassed with either arteries or veins, (oh, and uh, that’s after the transplant obviously).

Now that you know the difference between these codes, don’t go running off and arbitrarily using them just because you see the patient has had a bypass. The same patient could have CAD in native and/or bypass vessels. That’s where any cardiac catheter reports or asking the doc for some clarification is the best way to know which vessels are affected.

There are two other codes in the ICD-9 that likes to trick unwary coders into thinking it’s the correct code for stenosis or occlusion of coronary bypass grafts. It’s 996.03 Mechanical complication due to coronary bypass graft and 996.72, other complications due to other cardiac device, implant, and graft. These may look like a duck and talk like a duck but they are definitely not ducks. Using these codes for coronary bypass stenosis is… well, to put it bluntly… the work of a lazy coder. The number one rule of thumb in coding is to READ your coding books. Understand what the punctuation marks mean, read the “excludes” and “includes” notes in the category sections. All the information is there for you; don’t be lazy and use it. With this said both of these codes have notes directly underneath each one which tell you plain and simple “for occlusion, stenosis or atherosclerosis of coronary bypass grafting use codes from 414.02-414.06”. This is, of course, a paraphrase but the point is the code points you directly to the right place.

Oh, and one last thing, please do not use 414.8 for unspecified CAD. If the record shows “coronary artery disease”, use 414.00-414.07. 414.8 is used for other ischemias of the heart such as chronic symptoms (chest pain, shortness of breath etc) after 8 weeks out from a heart attack.

The same type of coding is used for arterial disease in the other vessels of the body. These codes are found in the 440 category. Look at them carefully and you will find many parallels to the coronary artery codes of 414.

So you see, the coding of CAD is actually a pretty simple case to crack. Prying that super sized double cheeseburger and fries out of your hand and getting you to turn off Days of Our Lives is a whole other battle altogether. All you have to do is with every bite conjure up the sounds of a deep fat fryer and imagine that sound in the vessels of your body. Eeeww! I don’t know about you, but the sound of fresh running water is a whole lot more comforting. So what are you having for lunch today?

Until next time, mighty coders, here’s to your health and happy coding!

--Tara

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TeleWebinar Update

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

Wow, have I been busy getting new classes off the ground and I am pumped. We have four new classes planned and quite a few in development for those looking for education, compliance opportunities, and while they are at it, CEU’s. We have some returning speakers and some new ones, all first rate and tops in their field. Nothing less from CRN Continuing Education.

First, Patricia (Pati) Trites of Healthcare Compliance Resources will be joining CRN CE as both a speaker and her organization as a certifying body. She is very excited about the types of education we are bringing to coders, billers, consultants and those active in compliance. Pati wants to be part of this process and has scheduled to record three terrific courses to start with. I hope you will feel my excitement and sign up to learn what Pati has to teach so many of us. You can find out more about Pati and Healthcare Compliance Resources at www.complianceresources.com.

First, Pati will be teaching Employee Overtime-Is Your Practice At Compliance Risk? Many physician practices underestimate the risk involved in making a mistake in administering the wage/hour laws. One of the most common mistakes made is improperly classifying certain employees as exempt from the wage and hour laws and not paying overtime when it is required. What about work time while traveling and the overtime considerations. This has not only great impact on the practice’s operations, but on their compliance program. One of the key elements of a compliance program is your employee policy manual. Come listen to Pati speak on this very timely topic. She will be recording this class on 3/14/06, so the class will be available to purchase from the CRNShoppe TW_EmpOtCompliance as of the end of the week.

Pati’s second class will be on compliance; Mandatory Compliance Programs Have Arrived. The Deficit Reduction Act of 2005 has made it mandatory to have a fraud and abuse compliance program by Jan 1, 2007. This applies to all entities that pay or receive at least $5 million in Medicaid funds. Are you ready? Find out how to comply with the law. Even if you are not a large practice, there are a lot of small things you can do to start your compliance pathway. Come listen to what Pati has to say on this very timely topic. This will also be available the week of 3/20/06. To purchase the recording, go to TW_Compliance.

Pati’s third class is near and dear to my heart. The class, Evaluating EMR/EHR Systems for Compliance? addresses an area of EMR/EHR evaluation that seems to be overlooked in many system reviews. This is so important as the more we travel down the HIPAA security road and as automatic encoders become more prevalent, there will be more and more pressure on practices to prove that their electronic systems comply with certain audit and compliance issues. These systems are very expensive and their implementation is often a very rocky road. A practice cannot afford to take this lightly and not consider the compliance related issues when evaluating these systems. This recording will be available the end of the week of 3/20/06 and you can order it at TW_EMR-EHR.

Last, but definitely not least, Deb Grider is doing another minicourse for CRN CE on Coding Consulting 101. A lot of us are aware of the confusion that surrounds the “clarification” that CMS created when they updated section 30.6.10 of the Claims Processing Manual, and a lot of concern exist on how do we operate within the parameters that CMS has placed on the physicians, the practices and the coders. Deb brings clarity where there was fog and has some great suggestions for systems and procedures in the practice. She also has suggestions for you to bring back to your physicians on how they document the requests for consultations when they are truly requests for opinions. Deb has audited many charts, in and out patient and it is through that experience that she can bring understanding to this topic as well as practical operating advice. This class will be recorded just before the AAPC National Conference. It will, therefore, will be available just after conference, around 4/1/06. To order this minicourse, go to TW_ConsultationCoding101.

We have some other classes lined up for May as well. I received a few emails requesting classes on Neurosurgery. So, Voila, Eric Sandhusen is developing a two-part mini course series on Neurosurgery, part 1 on the spine and part II on the brain. We have also been requested to develop something on ASC’s. I have not started on that one, but I promise I will find the appropriate Subject Matter Expert (SME) for that topic. The point here is that a few people have emailed me with their needs and we have been able to be responsive with finding the right SME’s for those topics and got them scheduled. So, do not be afraid to email me at b.cobuzzi@att.net with our needs and I will look into whether we can get your needed topics scheduled.

Do not forget to look on the CRN CE web site at www.crnshoppe.com/tw and see all the classes that are already there available for purchase. There are a few on auditing, on appeals, on modifiers, on E&M, on radiology, on marketing the independent billing company, on non-physician practitioners and more. Go to the web site and see our ever-growing library of continuing education and CEU opportunities. Put a group around the phone (and if you want, a computer, but it is not necessary) and you all can listen to the class together for one fee of $139. What better, cost effective way do you have to educate your office? This is about having great teachers and timely topics that are worth the time and effort to listen and learn!

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, AMBA and 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:

	Employee Overtime-Is Your Practice At Compliance Risk? Patricia A. Trites, MPA, CHBC, CPC, EMS, CHCC, CHCO, CHP
	Mandatory Compliance Programs Have Arrived Patricia A. Trites, MPA, CHBC, CPC, EMS, CHCC, CHCO, CHP
	Evaluating EMR/EHR Systems for Compliance? Patricia A. Trites, MPA, CHBC, CPC, EMS, CHCC, CHCO, CHP
	Consultation Coding 101 Deborah Grider, CPC, CPC-H, CPC-P, CCS-P, EMS

Upcoming Speakers - Dates to be set

• Marvel Hammer
• Frank Cohen
• Pam Biffle
• Nancy Reading
• Caral Edelberg
• Terry Leone
• Linda Martien
• 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 April 1, 2006.

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 Susan Cafaro who is the Office Manager for Dr. Tully and Dr. Napierala, Ph.D.. Susan recently completed the 301 Physician Coding Course.

What made you decide to take a course? My friend, Gina Nuske, told me about the course and I wanted to further my career by taking the course.

Why did you pick CRN Institute? I liked that you could take work at your own pace throughout the course.

Is there anything you would say to someone thinking about taking a course? I feel this course was very informative and would suggest anyone interested in coding, take this course.

Do you currently have any coding/medical credentials? No coding credentials yet. I have been in the medical field for the past 15 years and doing some coding in my jobs.

Are you planning on sitting for a Board exam? Susan is planning on sitting for the CPC exam April 22nd in Canton , Ohio at Mercy Hospital. We look forward to reporting her success.

Any other comments? I want to thank you very much for all the help when I would have to call you. If you were not available you got right back to me as soon as possible.

If you are a CRN student and have recently gotten a new credential, job or have something exciting you want to share send it to me so you can be featured in our next issue.

Until next time...

--Pam

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CRN Member Highlight

Ardith Campbell , CPC

Where are you from?
Yakima , WA.

What is your favorite activity?
Reading, which is a good thing in this industry.

Do you have any hobbies?
Reading, shopping, playing piano.

What credentials do you hold?
Mom and CPC.

What organizations do you belong to and how have they helped your career?
My friend, Tammy, and I started our local AAPC chapter. In 4 years, I’ve only missed 2 meetings and one was because I was at National Conference. I usually speak 3 times per year for our local group. My involvement at a local level has given me the public speaking experience I needed for my current position.

How did you get into the field of medical billing and coding?
I started out on switchboard and back-up receptionist at the local community mental health center. I’d help out the billing personnel when I had time, and when a position opened up, I moved up. The rest has been personal effort to increase my knowledge.

What is your current position?
Currently, I am a Hospital Account Manager for CodeCorrect™. It has been very interesting to transition from the physician side and focusing on the facility side. Since I am certified, one of my job functions that differs from the other account managers has been with one of the products that takes a retrospective look at facility outpatient Medicare claims and to identify issues for the facility. This is a great company to work for, and they encourage continued education and to grow professionally.

What is one of your accomplishments in this field that you are most proud of?
Co-founding our local chapter and watching the growth of the members; not just the numbers of our chapter growing, but the personal growth of the members. Some of them have come in as students and I have watched them begin to branch out.

What do you find most exciting about this field?
The constant change and growth that occurs. There’s always something new to learn, and there is no way to become stagnant.

What do you find most frustrating?
Besides the coworker who used to whistle at me to come over to her desk to help her with a problem? I’d have to say it is trying to teach somebody who doesn’t want to learn. I feel that this is a problem no matter whether you’re on the provider side or the payer side.

What do you feel the future holds for this field?
This field holds so many possibilities it would be difficult to list them all. Truly, the sky can be the limit - billing personnel, coding personnel, reimbursement specialists, supervisory roles, compliance officers, nosologists, teachers, mentors, producers of change. It is encouraging to watch how the need for certification is becoming more and more recognized.

What would you tell someone just starting out in this field?
Become involved with your local AAPC chapter or contact your local community college to see if they have a coding/billing program. It is important to have others as a network to encourage each other and to be a resource.

If there was one thing you could change about this field what would it be?
Oh, how nice it would be if all payers in all states followed the same rules.

Who do you consider a mentor?
The CRN list, of course! It would be difficult to find a greater set of mentors anywhere. Whenever I’ve had a question, somebody has been able to help. I’ve learned so much by reading the posts and responses, which has helped broaden my sphere of knowledge and allowed me to apply it to different situations.

What is your favorite billing or coding product?
I haven’t used any yet, but planning on ordering some of the classes and anytime CEUs.

What is your affiliation with the CRN and how has that helped you?
Let’s see…back in 1999, I joined the CRN. The value I have received from the members has been invaluable. At that time, I had few other coders to network with. The list members have helped me learn about where to go to find things, how to search CMS, Federal Regulations, and how to use them. This has also helped me to become a reference for others in my community. Also, one of the reasons I have my current position is because my supervisor had seen my postings on the CRN list. How cool is that?

How can other members reach you?:
You can reach me at (509) 453-0400 extension 224, which is my work phone. I am on the phone sometimes for 90 minutes at a stretch, so please leave a message. My email address is ardithc2000@yahoo.com.

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