From the Founder

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

We’re baaaack! Greetings CRNers! We took a few months off to enjoy the summer but now we’re back in full swing. We have a great new partnership with the Coding Institute we are very excited about – more on that in future issues. In this issue Suzan gives us a rundown of the variety of topics being discussed on the listserv. To join the listserve go to http://www.codingandreimbursement.net/membership.php.

Then Tara, a.k.a. the coding sleuth, is back with a great preview of the 2007 ICD changes. Barbara gets us thinking about continuing education in her column and lets us know what she’s been cooking up for our CEU needs. Pam reminds us of the great courses the CRN Institute offers. And last but not least our Member Highlight this issue is of “bi-vocational” Diane Wilkenson, RHIT, CCP, CPHQ – check out her interesting story.

Until next time – happy coding!

--Laureen = )

[top]

by Suzan Hvizdash, CPC CRN Senior Auditor, Instructor

Topics! Topics! And even more topics! That’s what’s been going around on the List Serve lately. I usually try to showcase a few of the interesting threads on the list, but there have been so many lately, it is hard to pick. I thought I’d give a list of some of the topics that have been batted around over the past few weeks to get everyone motivated to visit the list.

The topics, as you can see, really did vary widely as each day passed.

If you haven’t started watching the list, please give it a try. As you can see from this list of topics, there is nothing we haven’t yet been able to discuss. When you have a question you just can’t seem to wrap yourself around, we are all here for you. And remember, if you are wrestling with the question, either someone else is too or they just found the answer and are ready to share.

Until next time:

Gallon of gas: $2.62
CPT Book: $28.00
Joining the CRN: $0
Joining the List serve: Priceless

Until next time,

--Suzan

[top]

The Coding Sleuth

by Tara Conklin, CPC

They’re Coming!

The wait is on. The 2007 ICD-9 Codes have been released and the waiting game has begun. We’ve seen them and now we fidget and fuss in our chairs, working with the current coding thinking to ourselves, “Oh, that new pain code would be so handy right about now.”

The best thing we can do while watching the calendar tick down to October first is to learn the codes and how to apply them appropriately. You know what, that’s a great idea, why don’t we do just that.

Come on, let’s take a peek at what’s to come in the world of diagnosis coding.

The first thing we notice perusing through them is where the emphasis has been placed. Several sections received more attention than others. Looking through these we notice they are:

Disease of the Blood and Blood Forming Organs
Nervous and Sense Organs
Disease of the Digestive System (especially disease of the periodontal and dental structures)
Complications of Pregnancy and Childbirth and the Pueriperium

A few other sections had additions and the complete list also covers deletions and revisions, but here we’ll look at some of the additions and how they will effect coding.

The first thing we’ll look at is neutropenia, which is a decreased level of neutrophils, a type of white blood cell. This condition is commonly found in viral infections and after radiotherapy or chemotherapy. Up until now this form of anemia has been coded with 288.0 Agranulocytosis and 776.7 Transient neonatal neutropenia, with this code specific to newborns.

Thankfully this year we see the addition of six new codes to report neutropenia.

288.00 Neutropenia, unspecified
288.01 Congenital neutropenia
288.02 Cyclic neutropenia
288.03 Drug induced neutropenia
288.04 Neutropenia due to infection
288.09 Other neutropenia

A few of these are pretty self explanatory such as congenital, due to infection and well, unspecified. Cyclic neutropenia is that occurring in cycles or regular intervals. It’s also known as periodic neutropenia.

Drug induced neutropenia would be used for chemotherapy, radiotherapy or any other drug that might have caused the condition.

The next section we look at is the neurological and sense organs chapter which sees a large bulk of the new codes this year. Expansive additions have been made to report encephalitis and myelitis.

323.01 Encephalitis and encephalomyelitis in viral diseases classified elsewhere
323.02Myelitis in viral diseases classified elsewhere
323.41 Other encephalitis and encephalomyelitis due to infection classified elsewhere
323.42 Other myelitis due to infection classified elsewhere
323.51 Encephalitis and encephalomyelitis following immunization procedures
323.52 Myelitis following immunization procedures
323.61 Infectious acute disseminated encephalomyelitis (ADEM)
323.62 Other post infectious encephalitis and encephalomyelitis
323.63 Post infectious myelitis
323.71 Toxic encephalitis and encephalomyelitis
323.72 Toxic myelitis
323.81 Other causes of encephalitis and encephalomyelitis
323.82 Other causes of myelitis
341.20 Acute (transverse) myelitis NOS
341.21 Acute (transverse) myelitis in conditions classified elsewhere
341.22 Idiopathic transverse myelitis

Myelitis is an inflammation of the spinal cord and encephalomyelitis also includes the brain. These conditions can be brought on by many separate factors. Looking at the codes they leave the bread crumb trail pointing to infections, other diseases, adverse effect of immunizations and toxic effects from drugs and external causes. Encephalomyelitis is often a late effect of stroke in which we would now use 323.81 to report this condition. Radiologists will find this very useful when coding this when it is found on MRI’s of the brain. There has never been a code in the past to report this often significant finding.

One of the most welcome and helpful additions we see in the coming year are the multiple new codes to report different types of pain.

333.94 Restless Legs Syndrome
338.0 Central pain syndrome
338.11 Acute pain due to trauma
338.12 Acute post-thoracotomy pain
338.18 Other acute postoperative pain
338.19 Other acute pain
338.21 Chronic pain due to trauma
338.22 Chronic post-thoracotomy pain
338.28 Other chronic postoperative pain
338.29 Other chronic pain
338.3 Neoplasm related pain (acute) (chronic)
338.4 Chronic pain syndrome

Many times patients are seen or treated for pain postoperatively, following other treatments, post traumatically or even other conditions such as cancer, in which new tests, work-up, or services may need to be performed independently of these primary conditions. Under the current codes and coding guidelines often the condition causing the pain is used to report medical necessity for these services. Howeve,r since the pain is the reason for the service and not the condition itself, often the diagnoses don’t support the medical necessity thus resulting in denials and wasted man hours working appeals on the backend. Thankfully, with the following new codes, services directed specifically for pain can now be accurately coded.

Moving right a long we come to the next major section change. Fortunately (or not) a large portion of the additions will have little to do with the medical side of coding and billing and are more for our friendly neighborhood dentists. The dental and periodontal structure section received a serious booster. Multiple codes for gingivitis, periodontitis, and complication of dental restorative structure were added. The new codes are found in the gastrointestinal chapter in the 523-528 code ranges.

But fear not, the pearly white weren’t the only part of the GI system to get some attention this year. New codes for mucositis will be available:

528.00 Stomatitis and mucositis, unspecified
528.01 Mucositis (ulcerative) due to antineoplastic therapy
528.02 Mucositis (ulcerative) due to other drugs
528.09 Other stomatitis and mucositis (ulcerative)
538 Gastrointestinal mucositis (ulcerative)

Mucositis is an inflammation of the mucous membranes lining the digestive tract. These lead from the mouth all the way to the anus. This is a common side effect of chemotherapy and/or radiotherapy but can be cause by other factors such as an adverse effect to other types of drugs. Stomatitis on the other hand is an inflammation specifically of the oral mucosa. There can be multiple causes of this condition and may effect the buccal and labial mucosa, palate, tongue, floor of the mouth and the gingivae. Some of these factors can be allergic reactions, dentures, infection, viral, smoking and even poisoning such as from lead or mercury, to name a few. The new codes have also included the word “ulcerative’ in their descriptions. Since this is in parenthesis, it’s not a diagnostic requirement and simply means these codes include that with this additional complication when it’s found.

Traveling through chapters, our next set of major revision should make Obstetricians and Radiologist alike very happy. Unfortunately, the addition of many new codes this year reflects a sign of the times. Codes for tobacco use, obesity, and bariatric surgery status have all been added to the complication of pregnancy section.

649.0(0-4) Tobacco use disorder complicating pregnancy, childbirth, or the puerperium
649.1(0-4) Obesity complicating pregnancy, childbirth, or the puerperium
649.2(0-4) Bariatric surgery status complicating pregnancy, childbirth, or the puerperium

Additional codes for this section include coagulation defects, epilepsy, spotting and uterine size date discrepancy complication during pregnancy.

649.3(0-4) Coagulation defects complicating pregnancy, childbirth, or the puerperium
649.4(0-4) Epilepsy complicating pregnancy, childbirth, or the puerperium
649.5(0, 1, 3) Spotting complicating pregnancy
649.6(0-4) Uterine size date discrepancy

Remember when using codes from the pregnancy and complication of pregnancy section to pay close attention to the fifth digits. Not all fifth digits are applicable to all codes, such as in the new spotting codes. Only the fifth digits of 0, 1, and 3 are appropriate for this code range. Always apply the correct fifth digit in this section based on the patient’s pregnancy status at the time of the exam being reported.

Some other stand out codes we’ll see added in the New Year include:

Compartment syndrome, - 729.7(1-9) for nontraumatic and 958.9(0-9) for traumatic
780.32 Complex febrile convulsions
780.96 Generalized pain
780.97 Altered mental status
784.91 Postnasal drip
784.99 Other symptoms involving head and neck
788.64 Urinary hesitancy
788.65 Straining on urination
793.91 Image test inconclusive due to excess body fat
793.99 Other nonspecific abnormal findings on radiological and other examinations of body structure
995.27 Other drug allergy

Many of these will be welcome additions for most specialties but most beneficial to radiology and diagnostic testing. Up until now there have no specific codes to accurately report such conditions as “generalized pain”, “altered mental status”, “or postnasal drip”; conditions commonly found that require the use of radiological and pathological services.

Lastly the upcoming ICD-9-CM unfortunately sees the addition of V codes to report body mass indices resulting from childhood obesity. They might be useful for coding and treatment purposes but sadly they again reflect the sign of the times, particularly here in the United States.

This is not an all inclusive list of the new codes we can look forward to seeing on October 1st, but the bulk of the codes have been provided. Remember, there is no longer a grace period for new codes and once these changes go into effect codes from our current 2006 coding manuals that might be effected by these changes will be obsolete. Use of the current coding manual after this date will result in denials. Be sure to get accustomed to the new codes - not just the additions but also see what’s been revised and deleted. See where your practice will find them most beneficial. Educate your physicians and staff, particularly the billing staff so they can watch for denial errors on the part of private payers. We all know they like to slip the new codes through the cracks after implementation. Keep on them and stay on top of what’s coming and going.

With each New Year we are faced with new changes and challenges in coding. Facing them head on ensures improved reporting and better accuracy for all.

--Tara Conklin, CPC

[top]

TeleWebinar Update

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

Summer is almost over, we are all back from our respite called summer vacation, the children are back in school and the older ones are back in college. For us, it is also a time to think about continuing our education and making sure we stay ahead of the curve with our ever changing industry. The only way to do this is to search out the best of the best in educational opportunities and the only way to do it cost effectively is to find an organization who thinks about the membership first. Who might provide such a service? You guessed it, CRN Continuing Education. Am I that transparent?

Actually, I spent the summer talking to a lot of terrific speakers and lined them up to do teleconferences so that we can increase our library of offerings. The first of those priorities was to get the expert of all experts in the early fall topic of ICD-9 so that we could provide our membership with a terrific 2007 ICD-9 update as early as possible. As a result, Sheri Bernard of Ingenix, the one that literally wrote the book has recorded a telewebinar for CRN Continuing Education on an overview of 2007 ICD-9 Changes. I listened in as she recorded it and I have to tell you that she is good, really good. She gives insight into the changes and clinical aspects to the ICD-9 codes that I had not heard before. This is a terrific class and you can get it for only $139. The time to get it is now since you need to have your ICD-9 codes updated very soon, as of 10/1/06, just two weeks away. So, don’t miss this telewebinar and sign up at 2007 ICD-9-CM Diagnostic Code Changes

Speaking of updates, did you know that The Coding Institute and CRN has forged a strategic alliance?  With this alliance we can provide more services and discounts to the CRN membership.  And just in time, because TCI is offering special discounts through Aardvark Forms, the Global Medical Billing & Coding Store.  Aardvark is having a special sale going on now through September 20th for your 2007 ICD-9 manual.  Make sure you visit www.aardvarkforms.com for more info!  And of course, make sure you tell them you are a CRN member to get your full discount when you place your order!

Check out the listings of the recorded telewebinars on the CRN CE site.  Go to www.crnshoppe.com/tw for a complete listing.  As your certification renewal comes near, these classes are an easy way to not only earn the CEU’s you need, but to learn relevant material from some of the industry leaders at a cost effective price.

As I get more classes put together, please make sure you tell me what topics you are looking for.  You can email me at b.cobuzzi@att.net and tell me what you would like for CRN CE to feature in the future and I will search high and low for an expert in the topics you identify so that we can provide classes that are relevant to your needs.

Stay tuned and see what the future will be bringing in education on CRN CE.  Welcome back to school. Your essays on how you spent your summer vacation are due by the end of the month.  Class dismissed.

Latest Event Recording:

2007 ICD-9-CM Diagnostic Code Changes Sheri Poe Bernard, CPC, CPC-H, CPC-P

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

[top]

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 forming now!

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.

You might want to take a look at our self-study course in Pharmacology if you are planning on sitting for the CCS exam.

Most of you are aware that we offer courses in Medical Billing, Physician Coding and Hospital Coding. Were you also aware that we 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 that we offer payment plans $195.00 down and $100.00 a month.

Student Success Stories

Congratulations to Jill Cimirro, a Department Secretary in the Medical Records Department at Community Medical Center for completing the 301 Physician Coding Course.

What made you decide to take a course? I took the course to get more experience in the department I am in.

Why did you pick CRN Institute? I really liked how convenient it was to take the course at home.

What did you like best about the course? The course was in great detail of all the chapters.

What did you like least about the course? I thought the lectures were a little long but helpful.

Is there anything you would say to someone thinking about taking a course? I think this was an excellent choice and would recommend it to anyone.

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

[top]

CRN Member Highlight

Diane Wilkenson , RHIT, CCP, CPHQ

Where are you from?
Originally from Blytheville, AR; been in TN for 26 years (in Dyersburg, TN with MedSouth Healthcare/Practice Consultants since 1995).

What is your favorite activity?
Writing Southern Gospel music.  Have been successful in getting songs recorded since 1976.  Details at my web site, www.diannewilkinson.com.  I suppose one would call me bi-vocational…I love them both.

Do you have any hobbies?
See #3; also love old movies (REALLY old).

What credentials do you hold?
RHIT, CCP, CPHQ which is a holdover from my 25 years in the hospital business when I was over QM/JCAHO coordination, etc.

What organizations do you belong to and how have they helped your career?
Have been a member of AHIMA for 26 years…it’s been a blessing all the way through.

How did you get into the field of medical billing and coding?
I grew up in an Air Force Base town and got a civil service job when I was in my early 20s.  The base hospital had a small med/surg unit and a one-person medical record department.  I got that job with no previous experience in 1969, and coding was the first thing they taught me.  It’s almost 37 years later, and I still love coding and all forms of chart abstracting.

What is your current position?
I am compliance officer/quality manager for MedSouth Healthcare, a large multispecialty multilocation group in West TN ; we also have a separate LLC (MedSouth Practice Consultants) for my consulting services; go all over West and Middle TN doing teaching & compliance activities to our client physicians and their employees.  LOVE it!

What is one of your accomplishments in this field that you are most proud of?
I suppose my career highlight was in the last year of my hospital career when I led my hospital to a perfect score of 100 on a JCAHO survey.  It was an HCA hospital, and the first one to do so.  In the big picture, being allowed by the grace of God to have a career for 37 years that I love and am still able to do at 61 years of age.

What do you find most exciting about this field?
Everything!  Especially that moment when I see the “lights come on” when I’m teaching physicians the E&M guidelines and can really see that they are on board with me.  I have made a career out of getting doctors to do things they hate; have always been known as the gal who can motivate physicians.

What do you find most frustrating?
Medicare rules when they make no sense.

What do you feel the future holds for this field?
The sky’s the limit.  As long as doctors practice medicine and try to get paid for it, their services will have to be translated into something that can go into a computer.  And doctors will always need help from professionals like us to get this done.

What would you tell someone just starting out in this field?
You’ll know pretty quickly if you’re going to love it.  If you do, study and work hard, and the rewards will be great. I only hope this business is as good to you as it’s been for me.

If there was one thing you could change about this field what would it be?
I wish there were more uniformity and concensus about the rules that govern us.

Who do you consider a mentor?
My HIM director in West Memphis , AR , in the early 1980s was Mrs. Lois Cain, RRA, who was really a legend in Arkansas in our career field at the time.  She is a precious lady (now retired), a wonderful friend to me, and she taught me a LOT about things, which still stand me in good stead today.  I always worked with Quality Assurance in the hospitals, and it is practically identical to Compliance activities.  In fact, you even write the plan the same way.  She taught me how to write a QA plan.

What is your favorite billing or coding product?
I guess the ones I find the most useful are the specialty-specific Coding Alerts from The Coding Institute (available from www.CRNShoppe.com at a discount) that we subscribe to.  I also LOVE Nancy Maguire’s “Break Through the Modifier Maze”.  I used the Coding Clinic faithfully in my hospital years; considered it the definitive resource.

What is your affiliation with the CRN and how has that helped you?
The list serve.  It’s great!

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.

[top]

TIP from CRNCodingToday.com:
Many sections of the CPT book have section notes. These notes tell you special coding instructions for a series of codes. CRNCodingToday now has those notes available for you. Whenever you look up a code, check the top of the screen for the list of words in blue. Each of these words is linked to a specific section of the CPT book.

POINT>CLICK>CODE to view CPT section notes. Get it right! Use CRNCodingToday! It is fast! It is easy! It is correct!

What's new, exciting, and popular at CRN can be delivered to you automatically via . CRN provides news and information via a news syndication format called RSS (Really Simple Syndication)! RSS is designed for syndicating news, the content of news-like sites, personal web logs etc. Receive the latest RSS headlines to your desktop or browser and then just simply click on the links to read the articles. An RSS reader (i.e. Pluck) is required to read these articles and many of them are free to download. For more information and other free RSS reader downloads, please visit http://www.npr.org/rss/index.html. To subscribe to any or all of CRN 's RSS feeds please visit http://codingandreimbursement.net/forums/rss.php.

The CRN respects your time. We sincerely feel that this newsletter will be of interest to you. If you want to change your e-mail address or opt-out of this list click on one of the links below.

Join Discussion List - if you want to join the CRN-L and/or the CRN Web Forums or if you want to update your information on file with us click here.
Join Newsletter List - if this was forwarded to you and you want to be on the list that receives this newsletter click here.

If you want to continue receiving these e-mails and you don't want it filtered out of your inbox as "bulk e-mail" or "spam" then please add newsletter@crn-online.org to your address book.