Professional Association of HealthCare Specialists (PAHCS) Network News

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1 Professional Association of Healthcare Coding Specialists (PAHCS) also known as Professional Association of HealthCare Specialists (PAHCS) Network News In this edition PAHCS on ICD-10 Poverty guidelines Quarterly coding tips Annual Conference Nashville, Sept HCC Coding OIG work plan Coding for CEUs Volume 14 Number 2 Apr May - Jun 2015 One association with two names, servicing practice administrators, managers and coders in the medical arena. PAHCS on ICD-10-CM ICD-10-CM is scheduled to be implemented October 1, (subject to change, but, as it stands now, ICD-10 may actually happen) What does this mean to PAHCS members and certified coders? It s business as usual. PAHCS will continue to offer free ICD-10-CM training and we will NOT require certified coders to take a separate ICD-10-CM specific test to validate current credentials. PAHCS certified coders will be able to take a FREE, OPTIONAL online quiz on ICD-10-CM beginning in September, The quiz will be worth PAHCS CEUs and will not impact the coders credentials. THE SKY IS NOT FALLING! There is no need for expensive training, no need for special tests and certainly no need for a professional association to stress its members by having them take a special certification exam. Coders and Office Managers will have enough stress assisting providers through the transition. PAHCS is here to help. Our on line training videos are very helpful and once you actually get an ICD-10-CM in your hands and look at it, you ll find the conventions are still the same...just the codes are different. PAHCS is confident, and has verified, that professional coders will be able to adapt to changes brought about by ICD-10-CM. All Coders who have seen and worked with draft version of ICD-10-CM find that after a short time they are easily able to navigate the new codes and the new format isn t very confusing, it s just different. PAHCS will continue to provided ICD-10-CM training to our members. There are several on-demand webinars available free for PAHCS members in the PAHCS members only section of our website. As your professional association, PAHCS takes its obligation to support member coders very seriously; we are here to help you. YOUR PLAN for 2015: Go to and review the material. Look for the changes planned in your specialty. Get your doctor involved so your practice can move toward documenting charts and procedures based on ICD-10-CM standards. Start off slowly now, begin by asking the doctor to document one patient diagnosis to ICD-10-CM standards, see what s involved. PAHCS is confident that you ll find ICD-10-CM isn t nearly as difficult as some want you to think it is. In the big picture practices proactively preparing to transition to ICD-10-CM will easily make the conversion. Take advantage of all free ICD-10-CM programs available on line. ICD-10-CM isn t going to be that difficult to implement, if you prepare now. PAHCS, Like us on FACEBOOK

2 Using the Federal Poverty Guidelines By Marie Demastus, COCS, CHCI, CMCS The poverty guidelines are a version of the federal poverty measure. They are issued each year in the Federal Register by the Department of Health and Human Services (HHS) in February. The guidelines are a simplification of the poverty thresholds used for administrative purposes for instance, determining financial eligibility for certain federal programs, Medicaid or other types of financial assistance. A full background and explanation is published in the Federal Register notice of the 2015 poverty guidelines. The 2015 guidelines are as follows: 2015 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES & DISTRICT OF COLUMBIA Persons in family/household Poverty guideline For families/households with more than 8 persons, add $4,160 for each additional person. 1 $11, , , , , , , ,890 Persons in family/household 2015 POVERTY GUIDELINES FOR ALASKA Poverty guideline For families/households with more than 8 persons, add $5,200 for each additional person. 1 $14, , , , , , , ,120 These guidelines are particularly useful in the provider s office for establishing a patient assistance program for those with the inability to pay. They are a basis for income requirements and can be used at 100%, 150% or 200% for policy purposes. Combined with a simple application and proof of income, a standard patient assistance program is born, and can be used for patients across the board private pay or forgiveness of deductible, copay or coinsurance amounts for insurance patients, as long as the same criteria and standards are applied to all patients who indicate financial need. In most instances, an attempt to collect would be documented (three statement maximum) prior to write off. Page 2 PAHCS Network News Apr-May-Jun 2015

3 Quarterly CODING TIPS Utilize Preventative Medicine, Preventative Counseling and E & M codes to capture revenue for all aspects of a visit. CODING Network News Volume 14, Number 2 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 STAY IN TOUCH Local: Toll Free: Fax: Mail: 218 E. Bearss Ave., #354 Tampa, FL Web Site: pahcs@pahcs.org For initial comprehensive preventive medicine visit (such as establishing a new patient with the practice) codes are used and for periodic re-evaluation (such as an annual physical), use codes If the patient presents with a complaint (such as palpitations or ringing in the ears) that requires additional work, report procedure codes with a modifier 25 in addition to the preventative codes. When providing additional services such as documented counseling services for tobacco cessation add codes (Medicare allows $14.33-$27.53). Not all codes are covered by all carriers; however, it is imperative to capture and bill all services performed for accurate revenue management When delivering urgent or emergent care, consider using these add on codes in addition to the basic services provided Services provided in the office at times other than regular office hours or when the office is normally closed Services provided in the office during regularly scheduled evening, weekend or holiday hours Services provided between 10pm and 8am at a 24 hour facility Services typically provided in the office, provided out of the office at patient request Services provided in the office on an emergency basis which disrupts other scheduled office services Services provided on an emergency basis out of the office which disrupts other scheduled office services These codes are typically not covered by Medicare, however are considered by other carriers. They can also be negotiated into your contracts when the situation is a frequent occurrence in your practice. Additionally, if the codes are processed as non-covered, they are billable to the patient unless contractually excluded (ie: Medicaid). Apr-May-Jun 2015 PAHCS Network News Page 3

4 PAHCS 12 th ANNUAL CONFERENCE Homewood Suites-Nashville Airport, Nashville, TN September , 2015 Dawn R. Cloud, CPC, CMSCS, CMCS, CHCI: Dawn has over 20 years experience working in the medical field. She provides consulting services to physicians to maximize and manage their revenue through proper documentation, coding and billing. She is a national speaker, teaching and consulting for specialists. She is an active member of PAHCS and is the Dean of the PAHCS Academy. Ms Cloud has been involved in Arizona State Legislative training to be a patient advocate and physician liaison in the Arizona Government process. Marie B. Demastus, COCS, CMCS, CHCI: Marie is a ten year member and past President of PAHCS. Currently she is the education coordinator for PAHCS. She was the first PAHCS certified orthopaedic coder. Her background includes developing and teaching the medical insurance and coding curriculum for Withlacoochee Technical Institute. Marie has 30+ years experience in medical management, coding, billing and collections. Cynthia (Cindy) Penkala, BS, CMM, CMPE, CMSCS, CMCS, CPOM: is the Director of the Division of Practice Transformation and Member Education at the American Osteopathic Association. In her role at the AOA Cindy provides assistance to osteopathic physicians and their practices. She has over 7 years of medical association experience, having worked at the AMA prior to joining the AOA, and 18 years managing physician practices. She has worked as a consultant and owned her own medical billing company. Cindy was also honored to be named the PAHCOM 2006 Medical Office Manager of the year. SARAH PITTS HOLMES, MAL, CMCS, CPOM, COBGCS, CMM, HITCM-PP, CPCO: Sarah is the Executive Administrator of Metropolitan OB/GYN and Soapstone Center for Clinical Research in Decatur, GA. Having thirty one years of experience as a practice administrator has allowed her to manage her practice effectively and keep the practice on the cutting edge of medical technology and clinical research. Sarah is also an instructor at Clayton State University and has taught Medical Coding for nine years. Currently, she sits on the National Advisory Board of (PAHCOM) Professional Association of Healthcare Office Management and was the National 2013 Office Manager of the Year and is the current president of the Atlanta Chapter. Dedra Dyer CCS-P, CMM, CPCO, CAPPM, CMSCS, CMCS, CPOM: Dedra has a background in nursing and has worked in the medical field for 37 years. She is a certified coder and holds certifications in practice management and compliance as well. Dedra has spoken at several national conferences and serves on the National Advisory Board for PAHCS. She is the President of the Atlanta PAHCOM Chapter and currently serves on the National Chapter Support Committee for PAHCOM. She has been employed as the Practice Manager for Atlanta Lung Specialists, P.C. for 29 years. PAHCS, get the word out! Page 4 PAHCS Network News Apr-May-Jun 2015

5 PAHCS 12 th ANNUAL CONFERENCE Homewood Suites-Nashville Airport, Nashville, TN September , 2015 Monday September 14, 2015 Time CEU s Topic Speaker 8:00-12:00 0 Certification Exam for attendees testing 1:00-3:00 2 Non Physician Provider Guidelines Dawn Cloud, CPC, CMSCS, CHCI, CMCS, CPOM 3:00-5:00 2 Collections Marie Demastus, COCS. CMCS, CHCI Tuesday September 15, :00-10:00 2 Chronic, Transitional & Critical Care Coding Dawn Cloud, CPC, CMSCS, CHCI, CMCS, CPOM 10:00-11: Documentation; as it relates to ICD-10 and to ICD-9 Cindy Penkala, CMM, CMPE, CMSCS, CMCS, CPOM 1:30-3:30 2 Personnel: What's in your file Sarah Holmes CMM, CHCO, COBGCS, CMCS, CPOM 3:30 5: Subpoenas, Affidavits, Search Warrants Oh My! Dedra Dyer CCS-P, CMM, CPCO, CAPPM, CMSCS, CMCS, CPOM 8:30-10:30 2 Speaker Roundtable Wednesday September 16, :30-12:30 2 Effect of Healthcare Reform on your Practice Marie Demastus, COCS. CMCS, CHCI Conference Registration FAX this registration forms to; Or mail to: 218 E Bearss Ave Ste 354, Tampa, FL Or register online at ATTENDEE Registration (please print clearly) Registration Includes: All educational sessions Mon, Tues & Wed Breakfast and Networking! NAME: Title: PAHCS member # Specialty: Contact phone # Mailing City: State: Zip: TESTING? YES Conference Fees (chose only one option) Early Bird registration for PAHCS members (postmarked before July 4, 2015).....$300 Standard PAHCS member conference registration (postmarked after July 4 or paid at conference)...$400 #1 Conference registration and New PAHCS Membership fee (before July 4)...$420 #1 (after July 4 until conference)...$520 #2 Conference & EXAM for PAHCS members...$550 #2 (after July 4 until conference)...$650 #3 Conference & new Member &examination fee.$670 #3 (after July 4)...$770 PAYMENT Check (Please make checks payable to PAHCS) Credit Card: Visa M/C AmEx Discover Conference Refund Policy: Deadline for a full refund is August 1. Cancelation requests postmarked between Aug 1-Aug 15 will receive registration minus $75 administration fee. Cancellations postmarked after Aug 15, 2015, or attendees who do not attend, may forfeit all fees. PAHCS is not responsible for lunch, lodging or transportation expenses. --Make room reservations at Homewood Suites, Nashville Airport, TN call (615) special rates available through Oct 1, Apr-May-Jun 2015 PAHCS Network News Page 5 CC # Expire Date: Name on Card: Total to charge $

6 HCC CODING Specified Heart Arrhythmias (HCC92/96) An arrhythmia is a change from the normal sequence of electrical impulses that control the heart beat. The arrhythmic impulses can be too fast, slow or erratic. While they are usually harmless without treatment or management, some may cause serious damage to the heart and/or other organs due to blood clots and/or lack of oxygen. Some of the most common arrhythmia issues include: atrial fibrillation, bradycardia, conduction disorders, premature contraction, tachycardia, and ventricular fibrillation. Arrhythmia can be caused by acquired heart disease, congenital conditions, or chemical agents. Gender and age can also be a risk factor depending on they type of arrhythmia. Symptoms of arrhythmia may be so mild that they cannot be detected by the doctor or the patient or could be as severe as cardiovascular collapse and death. Patients may notice palpitations, a single premature beat or a series of these, or more serious symptoms such as fatigue, dizziness, light-headedness, syncope, irregular feeling heartbeat (rapid, slow, or pounding), chest pain, shortness of breath, and/or collapse and sudden cardiac arrest. The following must be found in the documentation: Start/frequency/severity of symptoms Family/patient history of heart related issues Medications Any symptoms that appear to worsen/improve Heart structure damage or abnormalities There are several tests that can be done to diagnose and monitor arrhythmia including: EKG, ECG, Holter & Event monitors, stress test, tilt table test, and electrophysiological testing and mapping. Most arrhythmias are harmless and are often left untreated, but patients can manage or avoid arrhythmia by reducing high blood pressure, controlling cholesterol levels, losing excess weight, eating a heart-healthy diet, avoiding tobacco products, participating in regular physical activity and learning to monitor their own heart rate. The main goals in the prevention and treatment of arrhythmia are to prevent blood clots, control heart rate, restore normal heart rhythm, treat causal disease/condition, and reducing other risk factors for heart disease and stroke. COMMON ICD-9 CODES Atriovent block complete Parox Atrial Tachycardia Parox Ventric Tachycardia Parox Tachycardia NOS Atrial Fibrillation Sinoatrial Node Dysfunction QUICK LOOK AT ICD-10 CODES I47.1 Supraventruclar Tachycardia I47.2 Ventricular Tachycardia F48.91 Unspecified Atrial Fibrillation R00.1 Bradycardia Unspecified Page 6 PAHCS Network News Apr-May-Jun 2015

7 OIG Work Plan By Marie Demastus, COCG, CHCI, CMCS The OIG (Office of the Inspector General) Annual Work Plan summarizes new and ongoing activities to protect the integrity of Health and Human Services operations. The OIG has identified reducing waste as a top management challenge facing the department. For the year 2015, the plan is extensive covering Hospitals, Nursing Homes, Hospices, Home Health Services, Medical equipment & Supplies, Prescription Drugs, Oversight of Part A and B contractors and Other Providers and Suppliers. Work planning for fiscal year 2015 and beyond will consider the following: Quality of Care: Planned work will examine settings in which OIG has identified gaps in program safeguards intended to ensure medical necessity, patient safety, and quality of care. They will also continue to focus on access to care, including beneficiary access to durable medical equipment, prosthetics, orthotics, and supplies in the context of new programs involving competitive bidding. Appropriate Payments: Planning is ongoing to expand OIG s portfolio examining inefficient payment policies or practices, including comparison among Government Programs to identify instances when Medicare paid significantly different amounts for the same or similar services or when less efficient payment methodologies were used. Planning is ongoing for work addressing Medicare costs incurred because of deficiencies in services or defective medical devices, as well as noncompliance or other vulnerabilities in care settings with high payment error rates. Oversight of Payment and Delivery Reform: Planning is underway to expand OIG s work addressing changes to Medicare programs designed to improve efficiency and quality of care and to promote program integrity and transparency. OIG will consider work examining the transition from volume to value based payments and the soundness and effectiveness of the payment structures, care coordination, and administration of these new payment models. Work expected to begin in 2015 and beyond includes examinations of data and metrics to document and measure quality and performance. Those items on the list for Other Providers and Suppliers are: Ambulatory surgical centers payment system End-stage renal disease facilities payment system for renal dialysis services and drugs Ambulance services questionable billing, medical necessity and level of transport Anesthesia services payment for personally performed services Chiropractic services questionable billing and Part B payment for non covered services Diagnostic radiology medical necessity of high cost tests Imaging services payment for practice expenses Selected independent clinical laboratory billing requirements Ophthalmologists inappropriate and questionable billing Physicians place of service coding errors Physical therapists high use of outpatient physical therapy services Portable x-ray equipment supplier compliance with transportation and set up fee requirements Sleep disorder clinics high use of sleep testing procedures For the complete 2015 OIG Work Plan go to index.asp#current. Apr-May-Jun 2015 PAHCS Network News Page 7

8 2nd quarter 2015 Answer all questions below correctly to receive 1 PAHCS CEU. answers to coder@pahcs.org. Be sure to include your name in the In what section of CPT are critical care codes found? a. radiology c. evaluation & management b. appendix A 2. HCPCS codes include a. vision services b. DME d. all of the above Professional Assn of HealthCare Specialists 218 E. Bearss Ave. #354 Tampa, FL PAHCS Annual Conference d. April Nashville, TN Sept (starts on Monday) c. both alpha and numeric Homewood SuitesNashville Airport 4. In what month do new ICD codes become effective? a. January c. December b. all numeric Two heads are better than one c. drugs b. False 5. Modifiers are a. all alpha CODING: d. none of the above 3. The 2015 component added to patient social history is military history a. True b. October SMARTER d. found in ICD Hope to see you there!