Thank you!
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationaleTag Archives: Article
BH services in an Article 28 clinic
If I am correct in saying we are not able to bill "incident to" then how do those services done by a CASAC get billed to MCR or can they not be billed?
There are conflicting views in that if the psychiatrist, MD and/or psychologist is overseeing the treatment plan then we can split bill the service, done by the CASAC, under the MD- is this accurate?
Last question, would the REV code for these services done in our clinics be the 900 rev code?
Any help would be appreciated. Thank you!
Healthcare Business Monthly Article from Feb 2018
I need help understanding the article titled "2018 OPPS Payments" on page 38. In particular the paragraph Packaging Expansion Continues in the article it states, Physician offices are not eligible for the payment of a visit if drug administration services are provided. I take this to mean that Medicare will no longer pay IM administration code 96372 with an E/M code.
The CMS NCCI edits effective Jan 1, 2018 do not reflect this edit. I also have not seen an email from Medicare confirming this packaging of services.
Can anybody clarify or confirm this?
Thank-You,
Nancy Jensen, CPC
Billing for Primary Care and specialist (Article 28 facilty) same day appt’s
Our Providers all work under the same tax ID this includes several Primary Care MD’s, PA’s and NP’s in addition to a Surgeon and Cardiologist All very beneficial services to a rural community as some patients will travel up to an hour for appt’s /procedures.This can be a hardship ,especially for our elderly that often brought to appt’s by their children (who have to miss a day of work in order to help their parents)
I have been told that because we are an article 28 facility and as the Providers work under the same tax ID we just can’t schedule any same day appt’s for specialist and Primary care As well that when a patient is a new patient for the Cardiologist ,Surgeon or PCP we can never use the 99201 -99205 codes Both reasons would cause the claim to be rejected and that only 1 of claims would be paid Even with use of modifier 59
I didn’t ask administration if they were using the newer more descriptive modifier XP as I felt I need to research the use before bringing that subject up, unfortunately I can’t find that needed information
I would love to be able to accommodate our patients better and as well be able to have the Providers reimbursed appropriately If anyone can advise me or direct me to the proper source for the information I would greatly appreciate your help I would have checked the NCCI edits but I believe that comes as a cost which I just can’t afford right now As well I don’t now that that would be specific for the article 28 facility ?? Wondering if well if there is a payer specific caveat
Thank you In advance for any advice, direction in this matter.
Cheri CPC-A
HealthCare Business Monthly article “Approach Matters for Spinal Arthrodesis”
[INDENT]Operative Report states: "a partial C5 corpectomy (30-40 percent) was performed , as the disk fragments had migrated inferiorly behind the C5 body, to safely retrieve the fragments to ensure that all the disk fragments were removed."
[INDENT]63081 CPT code Description: "Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve roots; cervical single segment"
According to CPT Assistant, April 2016; Volume 26, Issue 4, a cervical spine requires 50% of the vertebral body removed and the thoracic and lumbar requires at least 30% of the vertebral body removed. A copy of this CPT Assistant response is attached, along with an article on insertion of biomechanical devices.
Corpectomy surgery is a high risk procedure because the bone that surrounds the patient’s spinal cord for protection is being removed either partially or completely. Taking out the vertebral body to remove disk fragments seems to be an extreme measure; especially for a herniated disk and no other medical necessity information documented. Arthritis, cervical spine stenosis are typical types of reasons a corpectomy is done.
I just wanted to point this out because of risk to patients. If I am wrong, please speak up. Thanks for reading.
Article Review: The Coder Coach Responds to “Industry Disconnect”
I’m afraid today’s topic won’t be quite the entertainment fodder that many of my readers have come to enjoy because this is a serious topic and one that I am very passionate about. And it deserves a serious blog posting! Someone recently asked me on my Facebook page what I thought about a recent cover story published in For the Record Magazine. “Industry Disconnect” by Selena Chavis is a great read for anyone who has been pounding the pavement looking for a coding job. It is also a must read for any coding professional with hiring power. In short, this article highlights the biggest threat to the future of the coding industry: the ability to hire, mentor, and train recent grads.
It’s no secret how I feel about mentoring our future workforce. My thoughts are well documented throughout the Coder Coach and my colleagues in the state of Colorado know how outspoken I am about the topic of mentoring coders.
So when I was asked, I thought, wow, what a great topic for my blog. Here are my thoughts on the article: it illustrates an accurate, although bleak, outlook on the future. But all is not hopeless. This article has some great points, but it also brought to mind some myths about coding mentoring and training that I would like to address.
Myth 1: There is a disconnect between coding schools and employers and no one cares or is doing anything about it
Partially true. In general there is a disconnect between schools and employers, as documented in the article. It is not true that no one cares. Hello! Are you reading my blog? I currently sit on Colorado Health Information Management’s Student Alliance Task Force – a mouthful, I know! This is an alliance made up of CHIMA members and directors from the local HIM schools and we spend our time trying to figure out how to get better and more meaningful internship experiences for students. There are a ton of road blocks and we are trying to decide how to break them down. More on that in a sec.
Myth 2: Hospitals will only hire people who can hit the ground running
I hate this myth. Because, in my experience, there is no such thing as a coder who can hit the ground running. Okay, that was deep. Let me repeat with more emphasis, there is no such thing as a coder who can hit the ground running. It’s true that new grads take more time and as the article mentioned, there is only so much you can teach in a 2-year program that will prepare people for a future in electronic medical records, privacy and security, coding, cancer registry, and the list goes on. It is unrealistic to expect new coders to be able to hit the ground running and it’s ridiculous to exclude new grads thinking they won’t have anything to offer. I have never hired a coder – novice or experienced – who didn’t need on the job training. It’s true that you can teach an old dog new tricks, but it’s equally true that old habits die hard. A new coder may not have experience, but as Linda Donahue, RHIT, CCS, CCS-P, CPC mentioned in the article, it is easier to teach new habits than correct old ones. If you can absorb information like a sponge, you may have a serious future in coding.
On a side note, I decided to test this no-such-thing-as-hit-the-ground-running theory, so I called up my friend and newest coworker, Sandy Giangreco, RHIT, CCS, RCC, CPC-I, PCS, COBGC, CPC, CPC-H and AHIMA-Approved ICD-10-CM/PCS Trainer (are you getting the impression that Sandy has a little experience?!). I asked her if she felt like she’d hit the ground running and she said sort of. Now keep in mind that Sandy has many years of excellent coding experience (and a couple certifications!) and was hired by Haugen Consulting Group as a Senior Consultant. We don’t have to teach her how to code. But she is trying to get used to our way of doing things and our training materials so that she can further develop more materials and peer review other content. She is not up to speed yet. But it’s only like her second week, so I’ll cut her some slack!
Myth 3: If hospitals take the time to train people, they will just leave and take those skills elsewhere
Oh waaaa. Oops, did I type that out loud? This is something that industry leaders need to get over. We no longer live in an era where people pledge allegiance to a certain company and stay there for 30 years and retire to a blissful lifestyle at the age of 62. When I got my first coding job, my manager and mentor, Lila, told me she knew she wouldn’t be able to keep me but she wanted to give me an opportunity. And I am so thankful she did. There are other Lila’s out there who are willing to train you so they can have a hand in training the future workforce as a whole – not just at their own institution. I think if more people adopted this mentality, the future of the coding field would be bright indeed.
Myth 4: No one is willing to train on the job
So it turns out Lila was right. I worked for her for three years before taking a job as her peer coding supervisor at a sister hospital. And then she moved on for another career opportunity outside our hospital system. That was 15 years ago. Recently our paths crossed again when Lila took a management position with one of my clients. Last fall I got to travel with her during a training trip and it was so much fun to be back in the company of that person who first gave me a start. And I was dying to ask her: if you could do it all over again, in today’s climate of EMRs and code-based reimbursement, would you hire a green coder like I was back in the day? And she said yes. Here it is almost 20 years since she gave me a chance and so much has changed with coding and HIM and she still feels the same way about training and mentoring. God bless Lila and every coding manager like her. We also have a hospital system in Colorado that recently opened their own coding school in preparation for ICD-10 and they are accepting people with baseline coding class experience and placing them into coding positions at the end. People are willing to train, you just have to find them.
Myth 5: Experienced coders know more
Okay, so this may be where I lose some loyal blog readers and for that I apologize. I will start by saying that I know some really smart, terrific coders who can code like nobody’s business. And as a coding trainer, I also know a lot of “experienced” coders who don’t know as much as they think they do. At Haugen Consulting Group, we actually have a training program for experienced coders about coding basics or fundamentals where we get them back to the coding guidelines. Because they forget. They get so caught up in the details that they can’t see the forest between the trees. And it’s not really their fault. My point is, new coders may have an advantage here – we are trying to get coders back to the guidelines and most students know nothing but those guidelines. They are also “closer to the books” when it comes to things like anatomy and physiology. And I cannot stress enough How. Very. Important. This. Will. Be. For. ICD-10. No coder knows everything – it’s impossible. I learn more about coding every day and I teach the darn stuff. That’s actually what I love about it.
Myth 6: Coding students can’t get hands-on experience because of EMRs
There is some truth to this. I hate that word “can’t,” though. When I did my internship I reported to the hospital every day for 3 weeks like it was my job. There was a coding unit and all the coders sat together. I understand that that hospital no longer has a coding unit. The coders all work from home by accessing the electronic medical record (EMR). And that’s how most hospitals are these days. It’s not impossible for students to get hands on experience, but it is challenging. The main road block here is HIPAA. The Health Insurance Portability and Accountability Act of 1996 allows for electronic submission of health information and as HIM professionals, we understand the confidentiality and security issues surrounding protected health information (PHI). As HIM professionals, we have a duty to keep this data confidential but we also have the duty to train new professionals. We are trying to find ways to bust this excuse, but our first commitment is to the patient and protecting their data. That’s just something to think about when you complain about the background check you need to go through to get access to a system as a student. How would you feel if it was your medical record?
Myth 7: There are not enough coding jobs for students
Bologna. I’ve said it before and I’ll say it again. There may not be a bunch of jobs for “coder,” but there are tons of jobs that are coding related. Stop searching for coding positions in HIM departments and ending your search there. Start looking for jobs that have ICD-9-CM and CPT embedded in their job descriptions. You will learn more than you think just by being around codes. Plus, if you can get a job in billing, this is a great place to see coding reimbursement in action.
Wow, this is already way longer than I intended, so I will leave you with this. I love that Ms. Chavis’s article was the cover story. I think this is the most critical issue facing our industry today (even more so that ICD-10!). But I don’t want you to walk away from this article thinking that a future in coding is futile. Get out there and network! People give jobs to people they know, so go out there and get known!
If you haven’t found a job in coding, ask yourself if you’ve exhausted every option. I meet all kinds of people who want to be coders for all kinds of different reasons. If you want to be a coder only because you want to work from home, stop now. You won’t be successful. But if you want to be a coder because you love the detective work you have to do to pull documentation together to get those codes, then there should be nothing on this earth that will stop you. I see a lot of people making excuses about why they aren’t getting coding jobs, but I firmly believe that if you want it badly enough, you will get there. I’m no stranger to excuses myself – mostly when it comes to living a healthy lifestyle. So lately, I’ve been carrying around this quote as a reminder any time I catch myself making an excuse and falling into the role of victim:
“Ninety-nine percent of the failures come from people who have the habit of making excuses.”
-George Washington Carver
I am willing to work with my colleagues to remove the excuses about why we can’t train and mentor. Are you willing remove excuses for any of your own roadblocks that you’ve put up?
Coder Coach