CPT 2011: Overview of Major Code Changes

Transcription

1 HCPro, Inc., presents CPT 2011: Overview of Major Code Changes A 90-minute interactive audio conference Wednesday, December 1, :00 p.m. 2:30 p.m. (Eastern) 12:00 p.m. 1:30 p.m. (Central) 11:00 a.m. 12:30 p.m. (Mountain) 10:00 a.m. 11:30 a.m. (Pacific)

2 The CPT 2011: Overview of Major Code Changes audio conference materials package is published by HCPro, Inc., 200 Hoods Lane, P.O. Box 1168, Marblehead, MA Copyright 2010 HCPro, Inc. Attendance at the audio conference is restricted to employees, consultants, and members of the medical staff of the Licensee. The audio conference materials are intended solely for use in conjunction with the associated HCPro audio conference. The Licensee may make copies of these materials for internal use by attendees of the audio conference only. All such copies must bear the following legend: Dissemination of any information in these materials or the audio conference to any party other than the Licensee or its employees is strictly prohibited. In our materials, we strive to provide our audience with useful and timely information. The live audio conference will follow the enclosed agenda. Occasionally, our speakers will refer to the enclosed materials. We have noticed that non-hcpro audio conference materials often follow the speakers presentations bullet-by-bullet and page-by-page. However, because our presentations are less rigid and rely more on speaker interaction, we do not include each speaker s entire presentation. The enclosed materials contain helpful resources, forms, crosswalks, policies, charts, and graphs. We hope that you will find this information useful in the future. Although every precaution has been taken in the preparation of these materials, the publisher and speaker assume no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein. Advice given is general, and attendees and readers of the materials should consult professional counsel for specific legal, ethical, or clinical questions. HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks; the Accreditation Council for Graduate Medical Education, which owns the ACGME trademark; or the Accreditation Association for Ambulatory Health Care (AAAHC). For more information, please contact: HCPro, Inc. 200 Hoods Lane P.O. Box 1168 Marblehead, MA Phone: 800/ Fax: 781/ customerservice@hcpro.com Website: 2 CPT 2011: Overview of Major Code Changes

3 Dear Program Participant, Thank you for participating in our CPT 2011: Overview of Major Code Changes audio conference, featuring speakers Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and moderated by Michelle Leppert, CPC-A. Our team is excited about the opportunity to interact with you directly. We encourage you to ask our experts your questions during the program. If you would like to submit a question before the audio conference, please send it to the producer, Wendy Walsh, at wwalsh@hcpro.com and provide the program date in the subject line. We cannot guarantee that your question will be answered during the program, but we will do our best to include a good cross section of questions. Following the program, we would like your feedback in order to help us ensure a positive experience for our customers and deliver the best possible products and services. Because your time is valuable, we have limited the evaluation to a few brief questions found at the link below. Please forward the link to others at your facility who attended the program, so they can provide their input as well: To ensure that your completed form receives our attention, please submit it within six days after the live program. If you enjoy the audio conference, you may purchase a CD or audio on-demand copy for the special attendee price of just $70. Simply call our customer service department at 800/ and mention the source code SURVEYAD. Keep your copy handy and listen again at your convenience whenever you or your staff might benefit from a refresher or when your new employees are ready for training. At HCPro, we appreciate hearing from our customers. So if you have comments, suggestions, or ideas about how we can improve our programs, or if you have any questions about today s show, please do not hesitate to contact me. And if you would like any additional information about our other products and services, please contact our customer service department at 800/ Thank you, again, for attending the HCPro program today. We hope you found it to be informative and helpful and that you will continue to rely on HCPro programs as an important resource for pertinent and timely information. Sincerely, Leokadia Marchwinski Director of Multimedia Production HCPro, Inc. CPT 2011: Overview of Major Code Changes 3

4 CONTENTS 5 Agenda 6 Speaker profiles 7 Exhibit A Presentation by Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I 51 Exhibit B List of useful industry acronyms 56 Resources 4 CPT 2011: Overview of Major Code Changes

5 AGENDA I. Overview of changes II. III. IV. Overview of evaluation & management changes Critical care Overview of changes to surgery section V. Overview of changes to respiratory section VI. VII. VIII. IX. Overview of changes to cardiology section Overview of changes to medicine section Overview of changes to digestive section Overview of changes to urinary section X. Overview of changes to nervous section XI. XII. XIII. XIV. XV. Overview of changes to radiology section Overview of changes to pathology and laboratory section Overview of category II code changes Overview of category III changes Live Q&A CPT 2011: Overview of Major Code Changes 5

6 SPEAKER PROFILES Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP Jillian Harrington is president and CEO of ComplyCode, a healthcare compliance consulting firm in Binghamton, NY, and has more than 16 years of experience in the healthcare profession. She is the former chief compliance officer and chief privacy official of a large academic medical center, and also has extensive background in both the professional and technical components of CPT/ HCPCS and ICD-9-CM coding. Jennifer Avery, CCS, CPC-H, CPC, CPC-I Jennifer Avery is a senior regulatory specialist with HCPro, Inc., and a lead instructor for the company s Certified Coder Boot Camp Original Version (covers physician and outpatient hospital coding) as well as the Certified Coder Boot Camp Inpatient Version (inpatient hospital facility coding). She has extensive experience as both inpatient and outpatient coder for physicians and facilities. 6 CPT 2011: Overview of Major Code Changes

7 EXHIBIT A Presentation by Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I Current Procedural Terminology (CPT) is Copyright 2010 American Medical Association (AMA). All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. 7

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51 EXHIBIT B List of useful industry acronyms Source: HCPro, Inc. 51

52 Exhibit B AAPC American Academy of Professional Coders ABN Advance beneficiary notice ACDIS Association of Clinical Document Improvement Specialists ADR Additional documentation request AHA American Hospital Association AHIMA American Health Information Management Association AHRQ Agency for Healthcare Research and Quality AMI Acute myocardial infarction AOA American Osteopathic Association APCs Ambulatory payment classifications ARRA American Recovery and Reinvestment Act of 2009 ASC Ambulatory surgery center ASP Average sales price AWP Average wholesale price CAH Critical access hospital CC Complication or comorbidity CCHIT Certification Commission for Health Information Technology CCR Continuity of care record/cost-to-charge ratio CDI Clinical documentation improvement CDM Charge description master CERT Comprehensive Error Rate Testing CPI Consumer price index CMI Case-mix index CMS Centers for Medicare & Medicaid Services CMSA Consolidated Metropolitan Statistical Area COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L CPI Consumer price index CPT Current procedural terminology CRNA Certified registered nurse anesthetist CT Computed tomography CY Calendar year DED Dedicated emergency department DRA Deficit Reduction Act of 2005, Pub. L DRG Diagnosis-related group DSH Disproportionate share hospital ED EDMS EHR Emergency department Electronic Document Management System Electronic health record 52 CPT 2011: Overview of Major Code Changes

53 Exhibit B E/M Evaluation and management EMR Electronic medical record EMTALA Emergency Medical Treatment and Active Labor Act of 1986, Pub. L EOB Explanation of benefits ephi Electronic protected health information FDA FFY FI FY U.S. Food and Drug Administration Federal fiscal year Fiscal intermediary Fiscal year GAF GME Geographic adjustment factor Graduate medical education H&P History and physical HAC Hospital-acquired condition HCFA Health Care Financing Administration HCPCS Healthcare Common Procedure Coding System HCRIS Hospital Cost Report Information System HHA Home health agency HHS U.S. Department of Health and Human Services HIC Health insurance card HIMSS Health Information Management Systems Society HINN Hospital-Issued Notice of Non-Coverage HIPAA Health Insurance Portability and Accountability Act of 1996 HIS Health information system/services HIT Health information technology HITECH Act Health Information Technology for Economic and Clinical Health Act HMO Health maintenance organization HSA Health savings account HSRVcc Hospital-specific relative value cost center HQA Hospital Quality Alliance HQI Hospital quality initiative ICD-9-CM ICD-10-PCS ICU IHS IOM IPF IPPS IRF International Classification of Diseases, 9th Revision, Clinical Modification International Classification of Diseases, 10th Edition, Procedure Coding System Intensive care unit Indian Health Service Institute of Medicine Inpatient psychiatric facility Inpatient prospective payment system Inpatient rehabilitation facility CPT 2011: Overview of Major Code Changes 53

54 Exhibit B IT Information technology JCAHO Joint Commission on Accreditation of Healthcare Organizations LCD LTC-DRG LTCH Local coverage determination Long-term care diagnosis-related group Long-term care hospital MAC Medicare administrative contractor MCC Major complication or comorbidity MCO Managed care organization MCV Major cardiovascular condition MDC Major diagnostic category MDH Medicare-dependent, small rural hospital MedPAC Medicare Payment Advisory Commission MedPAR Medicare Provider Analysis and Review File MIC Medicaid Integrity Contractors MMA Medicare Prescription Drug, Improvement and Modernization Act of 2003, Pub. L MRHFP Medicare Rural Hospital Flexibility Program MS-DRG Medicare Severity DRG NAHIT NCCI NCD NCHS NCQA NCVHS NHIN NICU NPI NQF NVHRI National Alliance for Health Information Technology National Correct Coding Initiative National coverage determination National Center for Health Statistics National Committee for Quality Assurance National Committee on Vital and Health Statistics National Health Information Network Neonatal intensive care unit National Provider Identifier National Quality Forum National Voluntary Hospital Reporting Initiative OCE OCR OES OIG OMB OPPS OR OSCAR Outpatient code editor Office for Civil Rights Occupational employment statistics Office of Inspector General Executive Office of Management and Budget Outpatient prospective payment system Operating room Online Survey Certification and Reporting (System) 54 CPT 2011: Overview of Major Code Changes

55 Exhibit B PHR PO POA PPI PPS PRA PRM PRRB PS&R Personal health record By mouth Present on admission Producer price index Prospective payment system Per resident amount Provider Reimbursement Manual Provider Reimbursement Review Board Provider Statistical and Reimbursement (System) QIO Quality Improvement Organization RA RAC RBC RC RHC RHIO ROI RY Remittance advice Recovery audit contractor Red blood cell Revenue code Rural health clinic Regional health information organization Release of information (OR return on investment) Rate year SAF SCH SNF SOCs SSA SSI ST Standard analytic file Sole community hospital Skilled nursing facility Standard occupational classifications Social Security Administration Supplemental Security Income Status indicator TAG Technical Advisory Group UHDDS Uniform Hospital Discharge Data Set WBC White blood cell ZPIC Zone Program Integrity Contractor CPT 2011: Overview of Major Code Changes 55

56 56 RESOURCES

57 From our team to yours This is how we say Thanks! Thanks for being an integral part of today s audio conference. Participation, questions, and follow-up comments from you and your peers help HCPro continue to develop quality audio conference programs you can use to train staff, improve internal processes, and meet regulatory demands.» While you re at the Marketplace, sign up for any of dozens of free weekly e-zines. It s fast and it s easy! This is how we show our thanks Visit us online at and redeem this coupon for 20% off any one item of your choice. You may select today s audio conference sponsor product, any newsletter, book, video, package of handbooks, or perhaps your next audio conference. If you prefer, call our Customer Service Team at 800/ and mention Source Code MAUDIO20, or complete the order form below and fax it to 800/ The choice is yours. The pleasure is ours. 200 Hoods Lane P.O. Box 1168 Marblehead, MA Tel 800/ Fax 800/ customerservice@hcpro.com Web HCPro, Inc. HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. Product Price Order code Quantity Total Order online at Enter your source code at checkout TO SAVE 20%! Your order is covered by HCPro s risk-free, money-back guarantee THIS OFFER EXPIRES IN 30 DAYS Shipping* (see below) Sales tax $ (see below)** Grand total $ 2 SHIP TO: (Shipments CANNOT be delivered to P.O. boxes) Your source code: MAUDIO20 Telephone Fax address BILLING OPTIONS: Bill me. Check enclosed (payable to HCPro) Bill my (3 one): VISA MasterCard AmEx Bill my facility with PO # Signature (Required for authorization) Account no. (Your credit card bill will reflect a charge to HCPro) Exp. date *Shipping-Newsletter shipping $24/year, $27 to AK, HI, PR; Books and Videos $10 on orders under $100, $18 on orders over $100; Handbooks $5 pack, $15 pack to AK, HI, PR. **Tax Information Please include applicable sales tax. States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NY, OH, OK, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV. State that taxes products only: AZ. Expedited Delivery is available; please call our customer service department at 800/

58 Speaker contact information Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP President and CEO ComplyCode Resource Management 57 Woodlawn Drive Binghamton, NY Phone: 607/ Jennifer Avery, CCS, CPC-H, CPC, CPC-I HCPro, Inc. 200 Hoods Lane Marblehead, MA Website: HCPro sites HCPro: HCPro s mission is to meet the specialized information, advisory, and education needs of the healthcare industry and to learn from and respond to our customers with services that meet or exceed the quality that they expect. Visit HCPro s website at to take advantage of our new Internet resources. At you will find the following:»» The latest news, advice, and how-to information in the world of healthcare»» Free newsletters covering everything from survey preparation and Joint Commission standards to healthcare credentialing and health information management»» Your healthcare questions, answered by HCPro s experts»» Weekly tips about how to perform your job at your best»» In-depth, how-to stories in our premium newsletters, including Briefings on The Joint Commission, Medical Staff Briefing, and the Credentialing Resource Center (paid subscriptions or pay-per-view required to read premium newsletter content)»» The most comprehensive products and services (available through our online store, HCPro s Healthcare Marketplace at to help you tackle the tough issues that you face on the job every day»» All of the information and resources that you need about the following topics: 58 CPT 2011: Overview of Major Code Changes

59 Accreditation Case management Corporate compliance Credentialing/privileging Executive leadership Finance Health information management Hospital pharmacy Infection control Long-term care Marketing Medical staff Nursing Pharmaceutical Physician practice Quality/patient safety Rehab Residency Safety HCPro continues to offer the expert advice and practical guidance on which you ve come to rely to meet your daily challenges. This valuable information will be available to you 24 hours a day, seven days a week, via the Internet. The Revenue Cycle Institute: The Revenue Cycle Institute is your go-to source for services and tools to achieve revenue integrity. Expert consultants and educators provide audits, assessments, operational reviews, and customized training programs. Visit our website for white papers and news updates at com. The Greeley Company, a division of HCPro: Get connected with leading healthcare consultants and educators at The Greeley Company s website at This online service provides the fastest, most convenient, and most up-to-date information about our quality consulting and national training offerings for healthcare leaders. The Greeley website offers a complete listing of all of our products and services, including consulting services, seminars, conferences, and links to other HCPro offerings. CPT 2011: Overview of Major Code Changes 59

60 At you will find the following:»» Detailed descriptions of all of The Greeley Company s consulting services»» A catalog and calendar of Greeley s national seminars and conferences, as well as available CMEs»» Faculty and consultant biographies that introduce our senior-level clinicians, administrators, and faculty, who are ready to assist your organization with your consulting needs and seminars»» An ask the expert Q&A»» A list of Greeley clients»» A link to free newsletters HCPro s Healthcare Marketplace: Looking for even more resources? You can shop for the healthcare management tools you need at HCPro s Healthcare Marketplace ( Our online store makes it easy to find what you need, when you need it, in one secure and user-friendly e-commerce site. At HCPro s Healthcare Marketplace, you ll find all of the newsletters, books, videos, audio conferences, online learning, special reports, and training handbooks that HCPro has to offer. Shopping is secure, and purchasing is easy with a speedy checkout process. 60 CPT 2011: Overview of Major Code Changes

61 Brian K. Bussey Chief Executive Officer HCPro, Inc. a 90-minute audio conference on December 1, 2010 CPT 2011: Overview of Major Code Changes attended Certificate of Attendance