Network News. Volume 6 Number 4 October-November-December 2008 ADDRESSING THE NEEDS OF SPECIALTY CODERS AND PLANTING THE SEEDS FOR A BRIGHT FUTURE.

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1 Professional Association of Healthcare Coding Specialists (PAHCS) CODING Network News Volume 6 Number 4 October-November-December 2008 ADDRESSING THE NEEDS OF SPECIALTY CODERS AND PLANTING THE SEEDS FOR A BRIGHT FUTURE. More on these topics, INSIDE and on-line: 1. November 6-7, 2008 PAHCS National Conference October 9 is the last day to get good room rates Look inside for Speaker topics Find out more about Specialty workshops Specialty workshops Share ideas and knowledge 2. Discover the PAHCS CE University 3. Who has become certified and who has recently joined PAHCS 4. Learn more, get involved in the List serv. You are part of the coding puzzle!!! 5. PAHCS introduces two new coding certifications; EMERGENCY MEDICINE (CEMCS) and DERMATOLOGY (CDCS) 6. Coding for CEUs (on the back page) 7. Not certified...but thinking about it? At you can find scheduled dates or you can request to have a special testing location set up in your local area. PAHCS offers special testing locations for groups of 5 or more (even if they are from different specialties). If you know 4 other coders who want to become certified, call the national office to set a date.

2 PAHCS HAPPENINGS Are you getting mail from PAHCS? Are you getting PAHCS ? If you have moved, changed offices or addresses let us know. Take a moment to update your contact information. 1) On the web at log on as a member and click on EDIT PROFILE (it s a link on the upper right side) 2) Call our offices at ) Send updated information in an to Lee@pahcs.org and we will make sure your information is updated in our databases. CE University 2008 PAHCS National Conference in Orlando Florida November 6 and 7, 2008 be part of an established network of coders, learn from nationally recognized experts, join specialty discussions on your specialty and HAVE FUN. Make conference and room reservations don t wait till last minute. If you learn one new code or how to better use the codes you know, your impact on your doctor s bottom line could be significant! National Specialty certification exam will be offered on Nov 5. Discover the PAHCS CE University Based on member input, PAHCS has developed a place where certified coders can accumulate CEUs from their own home. All you need is access to the world wide web, your membership login and password and you are ready to begin earning CEUs from home. If you don t remember your login or password, contact us and we ll help. Congratulations, Newly Certified PAHCS Members Caryl Compton CGCS Galviston TX Jean Deitch CGSCS Newark NJ Casina Clark COBGCS Tampa FL Jennifer Dowell CPODCS, COCS La Plata MD Cassandra Vestal CGCS Fredericksburg VA John Bishop CPC, PA-C, MS, Tampa FL CWS, CMSCS Charlene Lawrence CGCS Mayfield Hts OH Joyce Kingsbury CPODCS, La Plata MD COBGCS Christine Dennison CGCS Lutherville MD Julie Hefley COBGCS Ardmore OK Cindy Fisher CGCS Landcaster PA Karen Wahl CGCS Mayfield Hts OH Dana West CPODCS, CIMCS La Plata MD Michelle Cataldi CGCS Massapequa NY Darlene Cruz COBGCS Tampa FL Patricia Stepek CGCS Moon Township PA Debbie Bedell COBGCS Tampa FL Ronda Brandt CGCS Irving TX Deborah Jodway-Davis COBGCS Tampa FL Roxanne Hammond CENTCS Baltimore MD Debra Duke CPODCS Richmond VA Sherrel Mendoza COBGCS Tampa FL Gail McLean CGCS Huntington NY Van Nguyen GCGS Arlington TX Helen Alston CGSCS Tontitown AR Page 2 Coding Network News Oct-Nov-Dec 2008

3 From the President By Marie Demastus, CMM-Ret, COCS President of the National Advisory Board CODING Network News Volume 6, Number 4 ISSN Coding Network News is a quarterly publication of the Professional Association of Healthcare Coding Specialists (PAHCS). Entire contents copyrighted All rights reserved; reproduction in whole or in part is prohibited. Subscriptions are provided as one of the many benefits of PAHCS membership. For information on advertising, deadlines for article submission or reprint permission, FAX the PAHCS National Office It s Conference time! This is the first year for a November conference (historically it has been earlier in the year), and let me assure you, November in Florida is absolutely beautiful. Not only do you have the opportunity for superior networking, but also for a fun-filled trip to Orlando and all the nearby attractions. I encourage you to make time in your schedule and ask your practice to support your attendance to this conference. Take advantage of the small group setting, with a chance to actually talk one-on-one with your course presenters. Our instructors represent a wealth of knowledge and information, all of which is shared with you during the conference. The opportunity to increase your coding expertise is phenomenal in this setting, due to the combined proficiency of our featured experts. Meet old friends and make new acquaintances. Gain the benefit of problem-solving with your peers. Every office finds that others rise to the same challenges they do on a daily basis. The solutions to problems are sometimes only one conversation away. Don t miss this exceptional chance to network with other coding specialists. And remember, the opportunity to become certified in your specialty is also offered just prior to the conference. Make this a memorable conference return home armed with more knowledge and skill! STAY IN TOUCH Local: Toll Free: Fax: Mail: 218 E. Bearss Ave., #354 Tampa, FL Web Site: pahcs@pahcs.org Oct-Nov-Dec 2008 Coding Network News Page 3

4 FINALIZE YOU PLANS TO ATTEND THE 5TH ANNUAL PAHCS CONFERENCE NOVEMBER 6-7, 2008 You could benefit from a conference where attendees write- Never have I obtained so much information in a two-day conference, as I did at the PAHCS conference. Candy DeGraffenried, CGCS on the 2007 PAHCS conference in Las Vegas The conference begins on November 6, Call , for room reservations, tell them you are with PAHCS. Discounted room rates and room blocks expire on OCTOBER 9, 2008, then room rates will go up approximately $100, if they are available. Make conference reservations online at or call us at so we know how many will be attending. After October 9, 2008 conference fees may increase. Thursday - November 6th 8:30am-10am 1.5 Legal Obligations of Coders Michael Lowe Friday - November 7th 9am-12pm 3 Specialty Workshops see below 10am-11am 11am-12pm 1 1 Chart Auditing part 1 Chart Auditing part 2 Cecile Katzoff Dawn Cloud 12pm-1pm Lunch 12pm-1:30pm Lunch 1pm-2:30pm 1.5 Non Physician Providers John Bishop 1:30pm-4:30pm 3 Specialty workshops see below Thursday Specialty workshop topics: 1) 2009 ICD-9 Updates, by specialty 2) Round table - bring issues you want to discuss 3) 2009 CPT updates, by specialty 3pm-4:30pm 1.5 CMS Updates Marie West Friday specialty workshop topics: 1) Coding for Medical Necessity in your specialty 2) Coding problem areas, clearing the confusion 3) Round table - continuation Specialty workshops will be facilitated by speakers. Topics are subject to change based on attendees needs. Topics will generally cover 1 (one) hour but may be modified based on the needs and desires of the attendees. Page 4 Coding Network News Oct-Nov-Dec 2008

5 Michael Lowe, Esq. Legal obligations of coders The presentation will cover the basic principles of relevant federal regulatory statutes which impact coders. The goal of this presentation is to educate attendees on the basics of applicable health care regulatory laws and hot focus areas in billing and coding by government agencies and private health insurers. We will also discuss liability issues for billers and coders and help them to be aware of how those issues can impact the day-to-day performance of their job duties. It will be highly interactive and strongly encourage questions and answers. Chart Auditing (Part 1) - Protect your practice The health care industry is one of the country s highest regulated industries. Monitoring compliance with regulations is the role of several federal and state agencies including the CMS, the OIG, federal and state attorney general s office, and the FBI. More money is being allocated for identifying and prosecuting fraud and abuse. The chances of being audited are higher then ever before. To minimize audit exposure and maximize reimbursement, it is critical that every practice review a sample of medical records compared with the CPT/HCPCS and ICD-9 codes billed at least once per year. This session will help select an appropriate sample and use auditing techniques used by CMS and the other federal and state agencies to review documentation and insure compliance. Chart Auditing (Part 2) Cecile Katzoff, MGA, CGCS Dawn Cloud, CPC, CMSCS (See article on page 7) John Bishop, PA-C, CPC, MS, CWS, CMSCS Non Physican Practitioners Identify what physician supervision rules apply to NPPs. Can NPPs perform initial assessment exam of patients entering SNF? How to get managed care companies to recognize and pay for NPP s services. Learn how to bill a shared visit. Learn which modifiers to use and when for NPPs. Incident To How, who, when and why? Updates on current information from the Centers for Medicare and Medicaid Services (CMS) Marie West, CCS-P, CMSCS, CCP Oct-Nov-Dec 2008 Coding Network News Page 5

6 What is the PAHCS List Serv? The PAHCS List Serv is a way for members to communicate instantly to ask and answer coding questions. Members registered on the list serv can send to pahcsnetwork@codingtalk.pahcs.org and it instantly goes to EVERYONE on the list serv. Imagine having hundreds of coding experts ready to answer your question...or you could be the expert helping another coder. There is only ONE rule we ask you to abide by. Please, keep all communications professional and coding relevant. FYI, when responding, to respond to EVERYONE just reply. If you want to communicate with ONE person ensure their address is the ONLY ONE in the to box. Less than 1/2 of all PAHCS members take advantage of this valuable benefit. To sign up for the list serv, log into the members only section of the PAHCS website ( and click on members then select the list serv option. You ll be taken to a page that asks for your address and name. Fill that in and submit and within 1 business day you will be on the list serv. Of course you can stop receiving list serv at any time. If you have not joined the PAHCS List Serv we highly recommend trying it out. Welcome, New PAHCS Members Alisa Smith Orlando FL Dione Segelke CGCS Lakewood CO Amber Kalkwarf Lincoln NE Donna Turnbow CMOM Fredericksburg VA Blanca Stelpflug Orange CA Jean Deitch CGSCS Newark NJ Caryl Compton CGCS Galviston TX Linda Larsen Coral Springs FL Cassandra Vestal CGCS Fredericksburg VA Lisa Griffin Rancho Mirage CA Christine Villapando Torrance CA Michelle Cataldi CGCS Massapequa NY Cindy Lamoureux Fairbanks AK Nancy Wettach Sarasota FL Dana Rea Little Rock AR Ricki Kozlowsky CPC Panama City FL Danielle Billieux Florence MA Sonia Munoz Rancho Mirage CA Debora Schulte CPC San Diego CA Sylvia Lara Alamogordo NM Deborah Wikstrom Lancaster PA Van Nguyen GCGS Arlington TX Desiree Baylin Red Lion PA Schedule and prepare for your certification exam now, your career will thank you! Currently scheduled Specialty Certification Examinations Oct 8, 2008 Oct 11, 2008 Oct 18, 2008 Nov 5, 2008 Nov 22, 2008 Las Vegas, NV Las Vegas, NV Tampa, FL Orlando, FL New York, NY Page 6 Coding Network News Oct-Nov-Dec 2008

7 Is your office in Compliance? The word compliance has several meanings according to Webster s dictionary, but the definition we are looking at is: conformity in fulfilling official requirements; compliance to the Medicare rules and regulations. There was a set of regulations posted in the Federal Register in October of 2000, (Federal Register / Vol. 65, No. 194 / Thursday, October 5, 2000 / Notices) that is the basis of what Medicare uses to audit practices; OIG Compliance Program for Individual and Small Group Physician Practices. In this article we are going to explore step one or baseline audits for your office compliance plan. Medicare suggests that at least once a year the Certified Coder or the head of billing sit down with the doctor and randomly pull 5 charts per government payer (i.e. Medicare, Medicaid, Tricare / Champus, Federal BCBS, etc) per doctor and audit the chart note. There are 4 main things coders need to look at when auditing: 1) Bills are accurately coded and accurately reflect the services provided (as documented in the medical records): The CPT and ICD-9-CM are supported by the legible documentation in the chart note for that day. Remember the chart note must stand alone, if other things such as history forms or test results are included in the code then it must be stated in your chart note. 2) Documentation is being completed correctly: Ensure the note is complete with the rendering Provider s signature and everything charged is reflected in the note. 3) Services or items provided are reasonable and necessary: Is everything ordered supported by medical necessity? (i.e., tests, supplies, etc.) 4) Any incentives for unnecessary services exist: Has something been ordered or performed that was not necessary but would benefit the Practice s bottom line? By doing this you understand where your office is in billing accurately against the documentation in the patient s chart. Whenever I have performed one of these for my offices I have found it very interesting. I have found undercoding which leads to loss of revenue, ancillary services or supplies that were not billed, lack of documentation to support services, etc. By doing this it educates not only the Physicians but everyone in the practice as a whole. If you find that you have been consistently overpaid you must take appropriate action such as education or in some cases refunds to the appropriate payer. If one particular Provider of service has problems coding accurately and/or completely against his/her documentation then you may want to do a concurrent audit of the chart notes until they are in compliance. Concurrent audit means that you compare every note against the coding prior to claims submission with daily education back to that Provider. It will always be a work in progress and I find that my Providers find it challenging and rewarding knowing that they are doing their part to be in compliance. Article submitted by: Dawn Cloud, CPC, CMSCS Oct-Nov-Dec 2008 Coding Network News Page 7

8 Answer all questions below correctly to receive 1 PAHCS CEU. Certificates will be mailed or ed to you. Include this certificate when renewing your PAHCS certification. 24 CEUs are needed every 2 years to maintain your certification. Answers can be ed to coder@pahcs.org or faxed to Which of the following terms means, of unknown cause a. etiology c. idiopathic b. manifestation d. late effect 2. A comorbidity is defined as: a. a problem acquired by the patient after birth c. a deformity b. a condition that coexists with a principal diagnosis d. the result of an injury 3. E codes are used to describe: a. extenuating circumstances surrounding an injury b. extra descriptors for coding c. exercise methods after injury d. external causes of injury and poisoning 4. NEC is the acronym for a. Nothing Else Coded b. Neoplasm behavior Essential for Coding c. Not Elsewhere Classifiable d. Not an Excluded Code 5. In ICD-9-CM, NOS means a. Not Otherwise Specified c. No Other Symbol b. No Other Sequence available d. No Other Secondary code SMARTER CODING: Two heads are better than one Everyone is being impacted by the current economic problems in the United States. Better utilize your practice $$$. Use the PAHCS list serv to communicate with other coders from around the country. It s like having extra staff members, for only $125 per year. Need an answer to a coding question, or are you looking for a best practice to help improve your bottom line, either way, the PAHCS list serv is there. Professional Assn of Healthcare Coding Specialists 218 E. Bearss Ave. #354 Tampa, FL 33613