CODING. Network News. Volume 13 Number 2 Apr May - Jun 2014 ICD-10 DELAYED!

Transcription

1 Professional Association of Healthcare Coding Specialists (PAHCS) CODING Network News In this edition ICD-10 Delay Upcoming webinars PAHCS happenings 2014 Conference: 1. Topics, Speakers 2. Schedule/registration Medical Records Documentation Coding for CEUs Volume 13 Number 2 Apr May - Jun 2014 ICD-10 DELAYED! It s official, the Senate, House and President have approved the delay of ICD-10. This delay means the earliest implementation of ICD-10 is now October 1, One of the conversations started by ICD-10 was about DOCUMENTATION. It s a conversation that we feel should continue and one that cannot be overstated. PAHCS recommends that coders and providers continue to review current documentation practices in the office and work towards ICD-10 compliance. Better documentation will never hurt a practice and we feel it equates to better patient care and might even expose revenue that is currently being overlooked. Even though ICD-10 has been delayed, once again, we don t want you to become complacent and just stop preparing for it. The Professional Association of Healthcare Coding Specialists recommends practices: 1) Continue preparing for ICD-10. If your practice purchased an ICD-9 codebook with ICD-10 codes listed (or an ICD-10 DRAFT copy) you are familiar with the new documentation standards and we recommend you begin integrating them into your practice. Another option is to visit or look up GEMs (General Equivalency Mappings) to find the new standards. 2) Providers, coders, billers and other staff need to be aware of the changes so everyone who now uses ICD-9 will know what will be expected when ICD-10 happens. PAHCS will continue to offer ICD-10-CM training to our members and we are certain that better documentation will only help a practice, even if ICD-10 is never implemented. In the big picture practices proactively getting ready to transition to ICD-10 will easily make the conversion. Take advantage of all free ICD-10 programs available on line. ICD-10 isn t going to be difficult to implement, if you prepare now.

2 Visit PAHCS sponsors on line: TurboCoder offers PAHCS members a FREE 2 week trial (log into the member section at You will also get a discount if you purchase TurboCoder). There s no obligation to buy, looking is free. UPCOMING Pay-per-view WEBINARS $25 per webinar, per logged in computer, PAHCS certified coders can use code freewebinar2014 and receive either of these at no cost. April 30 th (noon EST) - Guidelines for Diagnosis Coding (applicable to ICD-9 and ICD-10) by: Marge McQuade, CMSCS, CHCI Dig deeper into the guidelines for coding with ICD-9 and ICD-10. Revisit the conventions for Diagnosis Coding and learn useful hints. June 3 rd (noon EST) - Selection of Principal Diagnosis Coding by: Dawn Cloud, CPC, CMSCS, CHCI Understand how diagnosis codes work together to "tell the story" of the visit/encounter and learn how to appropriately pick the principal diagnosis for your encounter. Do you need these webinars? PAHCS Challenge: Answer 3 high missed True/False questions. Check page 6 for answers. How did you do? All webinars come with a money back guarantee, you can t lose! 1. The ICD-9-CM system translates physician services into codes instead of phrases or terms. 2. The term See category directs coder to use Volume 1, Tabular list, for additional information. 3. A late effect is defined as a residual effect or sequela of a previous illness, injury or surgery. PAHCS Happenings: 1. The PAHCS conference will be June and 27, 2014 in Orlando Florida, Embassy Suites, Jamaican Court. Page 3 has a synopsis of each program. Page 4 lists the speakers and page 5 shows the schedule and has the registration form. Make your plans and book a room as soon as possible. 2. Our ICD-10-CM training will remain online at If ICD-10 is implemented in 2015 we expect posted webinars will still be applicable. We will add more training material and if there are changes (other than the implementation date) we will update as necessary. 3. In June 2015 we will offer an on-line, free, optional ICD-10-CM proficiency quiz to our members. 4. PAHCS will not require a special ICD-10-CM exam for PAHCS certified coders to keep their certifications. Virtually all of our ICD-10 training will be free to our members. PAHCS considers it the obligation of a professional association to support our members. 5. PAHCS is now an international coding association as we just picked up our first overseas member. 6. The PAHCS Academy is taking off and we have several students enrolled. If you know of someone wanting to become a medical coder, PAHCS offers a great deal, excellent training and superior support. Page 2 PAHCS Coding Network News Apr-May-Jun 2014

3 Synopsis of presentations for the PAHCS 11 TH ANNUAL CONFERENCE Embassy Suites, Jamaican Court, Orlando, FL JUNE 25, 26, 27, 2014 Documentation & Your Physician By: Dawn Cloud, CPC, CMSCS, CHCI Come and hear the latest coding updates as it pertains to your Providers documentation. Learn valuable ways to help get them up to speed with current requirement as well as the potential upcoming ICD-10 changes CODING Network News Volume 13, 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 Conflict Resolution in the Office By: Marge McQuade, CMSCS, CHCI Learn the difference between conflict and crisis. Find ways to confront conflict and resolve it in a way to make you and your staff feel good about yourselves: Compliance: HIPAA & Personnel Issues By: Dedra Dyer, CCS-P, CMSCS, CMM, CHCO, CHCC, CAPPAM One of the most important aspects of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is its privacy protection. You will find out what employers need to know about the HIPAA privacy rule and basic privacy issues in the workplace. This information everyone needs to know. ICD-10 The Good, The Bad and the Ugly By: Steve Verno, CMMC, CMMB, NREMT, CEMCS, CMSCS Many issues that ICD-10 will bring are going to be discussed and how you can avoid the denials, and pitfalls of changing from ICD-9 to ICD-10. Importance of Risk Adjusted Reimbursement in the future of healthcare By: Dr. Todd Husty 1. Description of Risk Adjustment... how it works 2. Where it is used today and where it is going Chart Auditing By: Dawn Cloud, CPC, CMSCS, CHCI Come participate in a discussion on current methodologies for auditing your office E/M visits. Make sure your Providers are supporting their coding. Bring your examples to the seminar to have help auditing these claims. The Affordable Care Act 2014 By: Cindy Pekala, CMM, CMPE ACA, Obamacare, Health Care Reform, no matter what you call it, the impact on physician practices in 2014 was and is immense. This session will provide an overview on the changes in the healthcare industry and how they affect the physician practice and steps practices can take to deal with the current and future healthcare reform changes. Local: Toll Free: Fax: Mail: 218 E. Bearss Ave., #354 Tampa, FL Web Site: pahcs@pahcs.org Reason & Adjustment Codes By: Marie Demastus, COCG There are literally thousands of reasons a claim can be rejected or denied, paid improperly or just plain mishandled. Learn to decipher the language and codes for proper claim payment, and how to address issues in the most expedient manner. Apr-May-Jun 2014 PAHCS Coding Network News Page 3

4 Dawn R. Cloud, CPC, CMSCS, CHCI Dawn Cloud is the Dean of the PAHCS Academy and has over 20 years experience working in the Medical Field. She also provides consulting services to physicians to maximize and manage their revenue through proper documentation, coding and billing. She is also a national speaker, traveling the country teaching and consulting for specialists. Dawn is an active member of AAPC and PAHCS. She co-founded of the Kachina Coders, in the East Valley of Arizona, for AAPC. Ms Cloud has been involved in Arizona State Legislative training to be a patient advocate and physician liaison in the Arizona Government process. Marge McQuade, CMSCS, CHCI Marge McQuade has over 35 years experience in the medical field as an office manager, educator and coder. At present, Marge is the Director of Education for PAHCS (Professional Association of Healthcare Coding Specialists). Marge is a past Advisory Board member for several HCPro publications and currently is a contributing editor for BC Advantage. Dedra Dyer CCS-P, CMSCS, CMM, CHCO, CHCC, CAPPM Dedra Dyer 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 spoke 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. Steve Verno, CMBCS, CEMCS, CMSCS, Steve Verno s a Professor of Medical Coding and Billing Instruction at Florida Metropolitan University. Steve is also the Director of Reimbursement, Coding and Billing Training and Consultant with Emergency Medicine Specialists and a contributing editor for BC Advantage. Dr Todd Husty, DO, PA Dr Husty received his license to practice in Florida in He is a board certified in Emergency Medicine and practices Primary & Acute Care and Emergency Medicine. Dr Husty is the Medical Directory for City College, multiple SWAT teams and TMH Medical Services in Afghanistan. Between 1996 and 2008 he was a medical reporter/commentator for WESH-TV, NBC. In 1992 he founded Emergency Medicine and EMS Organization and Service and in 1993 he founded the Medical Audit Resource Services, Inc (MARSI). He is also an Associate Professor and Clinical Preceptor for the University of Central Florida Medical School. Cynthia (Cindy) Penkala, BS, CMM, CMPE Cindy Penkala is the Director of the Division of Practice Transformation and Member Education at the American Osteopathic Association. She has over 7 years of combined experience with medical association, having worked with the AMA and the AOA and 18 years managing physician practices. She has been a consultant and owned her own medical billing company. Cindy has over 35 years working in the medical field and holds a BS from National Lewis University. She is certified through PAHCOM, the American College of Medical Practice Executives and POMAA. Cindy was honored as the 2006 PAHCOM Medical Office Manager of the year. Marie Demastus, COCS Marie has been in office management, coding, billing and collections for over 30 years. She is a certified coder, who now specializes exclusively in Accounts Receivable Management. Marie has been a speaker at previous PAHCS conferences and is a 10 year member of the organization. Page 4 PAHCS Coding Network News Apr-May-Jun 2014

5 PAHCS 11 TH ANNUAL CONFERENCE Embassy Suites, Jamaican Court, Orlando, FL JUNE 25, 26, 27, 2014 Wednesday June 25, 2014 Time CEU s Topic Speaker 10:00-12: Documentation & Your Physician Dawn Cloud, CPC, CMSCS, CHCI 1:30-2:30 1 Conflict Resolution in the Office Marge McQuade, CMSCS, CHCI 2:30-4: Compliance HIPAA & Compliance Issues Dedra Dyer CCS-P, CMSCS, CMM, CHCO, CHCC, CAPPM Thursday June 26, :30-10: ICD-10 Good, Bad & the Ugly Steve Verno CMMC, CMMB, NREMT-P, CEMCS, CMSCS 10:00-11: The Importance of Risk Adjusted Reimbursement in the Future of Healthcare Conference Registration FAX this registration forms to; Or mail to: 218 E Bearss Ave Ste 354, Tampa, FL Dr. Todd Husty, DO, FACEP 1:30-3: Chart Auditing Dawn Cloud, CPC, CMSCS, CHCI 3:00 4: SPEAKER ROUND TABLE Friday June 27, :00-10:00 2 Affordable Care Act 2014 What a Year! Cindy Penkala, CMM, CMPE 10:30-12:30 2 Reason & Adjustment Codes Marie Demastus, COCS ATTENDEE Registration (please print clearly) Registration Includes: All educational sessions Wed, Thurs & Fri Breakfast and Networking! NAME: Title: PAHCS member # Specialty: Contact phone # Address: City: State: Zip: TESTING? YES Conference Fees Early Bird registration for PAHCS members (postmarked on or before June 1, 2014)....$350 Standard PAHCS & PAHCOM member registration (postmarked after June 1 or paid at conference)...$400. Non member registration (only)...$425 SPECIAL #1 Conference registration and New PAHCS Member application fee...$450 SPECIAL #2 Conference registration and EXAM for current PAHCS members...$550 SPECIAL #3 Conference registration, new Member application and examination fee...$650 PAYMENT (make checks payable to PAHCS) Credit Card: M/C AmEx Discover Visa CC # Expire Date: Name on Card: Total to charge Conference Refund Policy: Deadline for a full refund is June 1. Cancelation requests postmarked between June 1-June 25 will receive registration minus $75 administration fee. Cancellations postmarked after June 25, 2014, or attendees who do not attend, may forfeit all fees. PAHCS is not responsible for lunch, lodging or transportation expenses. Make room reservations at Embassy Suites, Jamaican Court, Orlando Fl, call (407) special rates available Apr-May-Jun 2014 PAHCS Coding Network News Page 5

6 Medical Record Documentation With the implementation of ICD-10 now delayed, most are breathing a collective sigh of relief. PAHCS feels this is an excellent time look at the basics of documentation and continue to learn what (if any) changes need to be made in your office to correctly document for ICD-10. Better documentation will never hurt a practice. An appropriately documented medical record can expedite claims processing, reduce errors and can serve as a legal document to verify the care provided. The medical record should be complete and legible (to nonmedical personal), utilizing widely accepted and recognized abbreviations and symbols. It should also be dated and authenticated (signed) by the physician. Documentation should support the intensity of the evaluation and/ or treatment, including thought processes and the complexity of medical decision-making. The codes recorded on the claim MUST be supported by the documentation in the medical record. The patient s progress including response to treatment, change in diagnosis and patient compliance and/or noncompliance should also be documented. From a coder s perspective, one of the most difficult hurdles to overcome is the desire to read into or assume missing information in the medical record to justify a code selection. Since the assumption of missing information is an individual choice, it is very dangerous and should NEVER be done. A coder should never fill-in, take out or assume that elements belong in the medical record if they are not there. Each E/M code should be evaluated on the documentation only and referring to information obtained from a prior history or exam is unacceptable grounds to make code assignments. If it wasn t documented...it wasn t done! The most important aspect of E/M documentation is that the complete clinical picture must appear in the medical record. One way to ensure proper documentation is to get your physician to embrace the SOAP (subjective, objective, assessment, plan) format. The subjective element is the patient s account of the problem they are being seen for. The objective element is the lab work or other undisputable findings. The assessment is the physician s professional opinion of the problem. The plan is the treatment for the problem. The key components of E/M coding which are history, physical examination and medical decision making correlate to the SOAP format. Insufficient documentation of history is a major reason for denying or downcoding claims. Of course, the level of history depends on the history of present illness; review of systems; and past, family and social history. Your office should review documentation standards in each of the SOAP areas to ensure the practice properly documents the history. Take a good look at how the practice gathers and updates patient histories. Do new patients fill out a thorough questionnaire? How detailed are the nurse's pre-exam questions and notes? Also, remember that while nurses or other clinical staff can record the review of systems and past, family and social history, the physician's documentation must supplement and/or make it clear the physician reviewed and confirmed the information that the other staff members gathered and documented. PAHCS National Conference June , 2014 Orlando, FL $350 per attendee PAHCS Challenge answers from page 3: 1) False 2) True 3) True Page 6 PAHCS Coding Network News Apr-May-Jun 2014

7 Questions on documentation that PAHCS has frequently received: (topic continued from previous page) A new patient comes in for a visit. The physician does a history and discusses the reason for the visit with the patient and refers the patient out to a specialist without performing a physical exam. Can an E& M code be billed without completing a physical examination? Yes, you can bill a low level new patient visit as long as the physician documents properly. Recommendation could be that a Level II E& M code (99202) be used. Can my physician count the time spent with the patient towards the level of E& M service billed? The time spent does not control the level of service to be billed unless more than 50% of the face-toface (for out-patient services) is spent providing counseling or coordination of care. If the documentation does not indicated counseling or coordination of care then time cannot be factored into the selection. My physician (a specialist) insists that all new patients seen be billed as a consultation. What is the rule for Consultation v/s E& M Code? If the patient comes to a specialist office with a referral from another physician, then a new patient E&M code should be used. For an office visit to be a consultation (ONLY if the patient is NOT a Medicare patient) it needs the 3 R s: (1) Request from a physician, (2) An opinion to be rendered, and (3) a report sent back to the referring physician. Always remember. The term New Patient is used for patients who have not received face to face professional services from the physician within the last 3 years. In a group practice, a patient is considered new to a physician if the patient has not been seen by another physician of the group WHO IS IN THE SAME SPECIALTY in the last three years. Documentation of each encounter should include: ο The patient s name and date of service. ο The reason for the encounter. ο An appropriate history and physical exam including any relevant health risk factors. ο The reason, results and review of diagnostic tests and ancillary services. ο Patient assessment and a treatment plan. The written treatment plan should include: treatments and medications specifying frequency and dosage; labs and tests; referrals and consultations; patient/family education; and specific follow-up instructions. ο The clear identity and professional credentials of all people who contributed to the service and/or record, and who contributed which portion(s) of the service and/or record. If it wasn t documented it wasn t done!!!! When documenting E/M services, make sure the service provided are clearly identified. If the provider documents and provides a level 5 service, it should be billed that way, and the same goes for any level E/M. We have spoken to coders who state my provider only wants me to bill a level 3 so they won t be audited.. FACT: a provider who always bills the same E/M level is more likely to be audited than one who correctly bills for the services they provide. Apr-May-Jun 2014 PAHCS Coding Network News Page 7

8 Second quarter 2014 Answer all questions below correctly to receive 1 PAHCS CEU. answers to coder@pahcs.org. Be sure to include your name in the . Second quarter 2014 True/False Indicate whether the statement is true or false. SMARTER CODING: Two heads are better than one 1. The E&M level of service reflects the amount of work involved in providing health care to patients. 2. A patient placed under observation is treated as an inpatient. 3. Four categories of decision making are: straightforward, limited complexity, minimal complexity, and high complexity. 4. Key components of an E&M code are: history, examination, and medical decision making. 5. Special E&M service could be used when a baseline evaluation of a patient applying for life or disability insurance is needed Professional Assn of Healthcare Coding Specialists 218 E. Bearss Ave. #354 Tampa, FL We recommend providers and coders continue to work toward documentation standards outlined in ICD-10. There is no way better documentation can hurt a practice!