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MEDICAL BUSINESS JOURNAL

April 2012 Issue 3 Volume 3

The Monthly Newsletter for the Informed Healthcare Professional

HHS has proposed a rule for a one year delay in the compliance date for the ICD-10 diagnoses and procedure coding system.

In this Issue 2.................................................................................................…...CoderWeek June 12-16, 2012 2............................................................…......…………………………….Contribute to the MBJ 2..............................................................................................……......…..Teaching Opportunities 2...........................................................................................…………….Join us on LearnerNation 2..............................................................................................……..….$150 Facebook Promotion 3.......................................................................................................................CMS News Updates Protect Yourself from Medical Identity Theft April is National Minority Health Month HPID under HIPAA Proposed Rule & Payment Changes for Inpatient Stays 4..................................................…………...................Changes in Cardiology by Latricia Partain 6................................................................................................................……….....ICD-10 Delay 7.............................................................................................................…..............Coding Corner


THE MEDICAL BUSINESS JOURNAL April 2012

Medical Management Institute Updates CoderWeek, Facebook, Careers & More MMI is Proud to Announce CoderWeek LIVE! The Medical Management Institute is proud to announce CoderWeek LIVE in Alpharetta, GA, June 12-16, 2012. It will be held at the beautiful Preston Ridge Medical Campus, where MMI recently moved. The week consists of 2 parts - a three-day CPC Boot Camp and a two-day ICD-10 seminar. The Boot Camp is geared towards passing the CPC or RMC Exam. Supplemental online materials, including a practice exam, are included. These 3 days are intensive training and meant for the more experienced coder, or a new coder who has done considerable review of the online materials before attending. The second part consists of 2 days dedicated to ICD-10 training. It is worth 14 CEUs (AHIMA and/or ARHCP), and AHIMA training workbooks and ICD-10 coding books are included. If you aren’t able to attend the live event, or don’t think you will be able to stay for the whole thing, no problem! CoderWeek is going to be recorded and available online as well. Online attendance is the same price as coming to the live seminars. Visit mmiclasses.com/land/coderweek.html towards register online, or you can call MMI at 866-892-2765 extension 214. There is also more details provided on the back of this Medical Business Journal.

Contribute to the MBJ The Medical Business Journals are the monthly newsletter for the informed healthcare professional, issued by the Medical Management Institute. As of November 2011, the MBJ’s are generally available online under your “Membership Corner”, or if you are an ARHCP member, available under your “Membership” tab. You can also access all future and archived issues through www.issuu.com/mmiclasses. If you would like to receive all future Medical Business Journals through regular mail, please email MBJ@mmiclasses.com to verify the shipping address you would like it sent to, or you can call MMI at 866-892-2765 extension 240. Please visit http://www.surveymonkey.com/s/ DR8XW3N to participate in a short online survey to help us improve the MBJ.

Careers at MMI We are proud to announce that the Medical Management Institute is looking to expand its roster of qualified, compassionate, and professional instructors for the second half of 2012 and beyond. If you feel that you are qualified to be a part of our instructor team for live instruction, student correspondence (including question and answer), webinar instruction, or content creation, please contact us. Email instructor@mmiclasses.com, or call MMI at 866-892-2765 extension 210. 2

Join us on Learner Nation Try out the exciting new learning platform on Learner Nation for free! The last two issues of the MBJ are available at no cost on Learner Nation. When you sign up for a full-price certification program, you can receive $200 back for completing a survey about your user experience! Contact MMI at student@mmiclasses.com or 866-892-2765 extension 210 to receive your username and password today!

New Facebook Promotion Join the Medical Management Institute on Facebook at facebook.com/MMIfan to access helpful resources, relevant news articles, and to be a part of our newest promotion. Right now, we have a Facebook drawing going for the chance to win $150 towards ANY of our services; this includes our RMM, RMC, CCS-P, or CPC Certification Programs, any extensions, books, continuing education courses, and more! Here are the details: 1. “Like” our Facebook page at facebook.com/ MMIfan, and have your name entered ONCE into the drawing 2. Comment on an article that’s already been posted and have your name entered TWICE into the drawing 3. Post an article on the wall along with a comment about how it relates to your workplace or what you’ve learned in a course and have your name entered FOUR times into the drawing 4. If you have a twitter account, “Follow” us @MMIclasses and have your name entered ONCE into the drawing Visit our Facebook page at facebook.com/MMIfan for more details- we look forward to going social with you! [If you are an ARHCP member, visit their facebook page at facebook.com/ARHCP to be a part of their on-going promotion as well]

Editor-in-Chief: Carleigh Thomson Copy Editor: Rob Hassett, RMC, Julia Scott, RMC, Carleigh Thomson Contributors: Latricia Partain, CPC, SCP-CA, RMC, RMM, Rob Hassett, Carleigh Thomson Layout and Design: Carleigh Thomson The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at: (770) 709.6928.


Protect Yourself from Medical Identity Theft Follow these steps proposed by CMS According to the Federal Trade Commission (FTC), medical identity theft “occurs when someone uses another person’s name or insurance information to get medical treatment, prescription drugs or surgery. It also happens when dishonest people working in a medical setting use another person’s information to submit false bills to insurance companies.” Examples could be your Tax ID Number (TIN), medical licensure information, and your National Provider Identifier (NPI). You may be victim if you are expected to pay taxes on earnings you never received or if you become the physician of record for services you had nothing to do with. According to Peter Bidet, MD, JD, Deputy Administrator for Program Integrity at CMS, you should protect yourself by taking the following steps. 1. Keep your medical information up-to-date. Any changes to Medicare, Medicaid, and other insurance companies should be reported. 2. Review billing notices. Actively review your Medicare remittance notices for items or services listed that you didn’t provide. 3. Protect your medical information. Only give your information to trusted and legitimate sources 4. Train your staff. 5. Educate your patients. Tell your patients to be on the lookout for fraudulent activity on their explanation of benefits statements, and how to report fraud when they see it. 6. Report any suspected medical identity theft. Call the CMS program integrity investigative contractor in your region, which you can find at this location: http://www.cms.gov/MedicareProviderSupEnroll/ downloads/ProviderVictimPOCs.pdf 7. Protect your prescription pads.

April is National Minority Health Month

services and in 2014 the Affordable Insurance Exchanges making it easier to purchase health coverage at more affordable rates, health equality is slowly becoming something attainable.

ICD-10 Delay & HPID Compliance date: October 1, 2014 The ICD-10 diagnoses and procedures coding system compliance date has been pushed back again to October 1, 2014 [more on this on page 6]. In addition to this extension, the U.S. Department of Health and Human Services (HHS) also proposed establishing a unique health plan identifier (HPID) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This rule will, according to CMS, “...save health care providers and health plans up to $4.6 billion over the next 10 years…[by] simplifying administrative processes for doctors, hospitals, and health insurance plans.” The rule simplifies the administrative process for providers by requesting that health plans have a standard length and format (unique identifier) for use in computer systems. This will allow providers to automate their processes, further simplifying the administrative side of health care.

THE MEDICAL BUSINESS JOURNAL April 2012

CMS News Updates

Proposed Rule & Payment Changes for Inpatient Stays Would generally be effective on or after October 1, 2012 CMS issued a proposed rule that would updated Medicare payment policies and rates for inpatient stays in acute care hospitals under the Inpatient Prospective Payment System (IPPS) and hospitals paid under the Long-term Care Hospitals (LTCH) Prospective Payment System (PPS) in fiscal year (FY) 2013. According to CMS, the proposed rule also proposes the payment update that would be used to calculate FY 2013 target amounts for certain hospitals excluded from the IPPS, such as cancer and children’s hospitals, and religious non-medical health care institutions. This proposed rule would generally be effective for discharges occurring on or after October 1, 2012.

Affordable Care Act is moving health equity in the right direction According to Cara V. James, Director of the Minority Health at CMS, 31% of Hispanics are uninsured versus 12% of non-hispanic whites, less than 1/3 of African American adults with diabetes receive the recommended services, and fewer than 40% of American Indian and Alaska Native adults over 50 have gotten screened for colorectal cancer. By these numbers alone, it is clear that something must be done to improve access to healthcare for the minority population. As of right now, with the Affordable Care Act improving access to preventative care

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THE MEDICAL BUSINESS JOURNAL April 2012

Changes in Cardiology 414.00 no longer has to stand alone By Latricia Partain, CPC, SCP-CA, RMC, RMM

Beginning in 2012, ICD-9 added codes for severely calcified coronary lesions (Chronic Heart Disease), which means that 414.00 no longer has to stand alone. This code is the unspecified type of the vessel or native or graft, and there are now 7 other codes you can choose from. Diagnoses of coronary artery disease or coronary heart disease without any further qualification has become too vague to be coded accurately. The physician has now been asked to provide a more specific diagnosis. To code 414.0x, Coronary atherosclerosis, includes conditions described as arteriosclerotic heart disease,

(ASHD) coronary(artery) atherosclerosis, coronary (artery) stricture, sclerosis or atheroma and arteritis or endarteritis. The definition: A chronic condition marked by thickening and loss of elasticity of the coronary artery, caused by deposits of plaque containing cholesterol, lipoid material and lipophages. A fifth-digit sub-classification indicates the nature of the artery involved. The best way that I have found to do this is to make an “example” chart to keep with me when I am coding. [Example chart below]

Native coronary artery—TIP: Documentation of CAD NOS in patient with no history of coronary artery bypass procedure—ASHD w/o ANGINA

414.01

Autologous vein bypass graft

414.02

• Plaque deposit in grafted vein origination within patient Nonautologous biological bypass graft--

414.03

• Plaque deposits in grafted vessel outside patient Artery bypass graft, (LIMA) Internal Mammary artery

414.04

• “Internal Mammary Artery” Plaque deposits in grafted artery within patient Unspecified type of bypass graft. Bypass graft NOS

414.05

Native coronary artery of transplanted heart. When atherosclerosis of a native coronary artery in a transplanted heart is identified in the diagnostic statement is when you would code 414.06

414.06

Bypass graft(artery(vein) of transplanted heart. This code is assigned to identify atherosclerosis of a bypass graft in a transplanted heart.

414.07

Coronary Atherosclerosis Native Coronary Artery ICD-9-CM 414.01 Coronary atherosclerosis Native coronary artery

ICD-10-CM I25.10 Atherosclerotic heart disease of native artery without angina pectoris I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm. I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris I125.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

414.02 Coronary Atherosclerosis autologous vein bypass graft

I25.710 Atherosclerosis of autologous vein artery bypass graft(s) with unstable angina pectoris I25.711 Atherosclerosis of autologous vein coronary artery bypass graft (s) with angina pectoris with documented spasm I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris

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Single- A pacemaker or cardioverter- defibrillator with pacing and sensing function in only one chamber of the heart. Dual- A pacemaker or cardioverter-defibrillator with pacing and sensing functions in only two chambers of the heart. Multiple- A pacemaker or cardioverter-defibrillator with pacing and sensing function in three or more chambers of the heart.

Procedure

Pacemaker

Defibrillator

Insertion single lead without generator

33216

33216

Initial pulse generator insertion only with existing single lead

33212

33240

Initial pulse generator insertion or replacement plus insertion of single lead

33206 (atrial) 33207 (ventricular)

33249

Removal generator with replacement generator only single lead system

33227

33262

Removal electrodes- single lead system

33234

33244

Insertion or replacement of temporary electrode

33210

Single

THE MEDICAL BUSINESS JOURNAL April 2012

PACEMAKERS VS DEFIBRILLATORS CHART

Dual Insertion dual lead without generator

33217

33217

Initial pulse generator insertion only with existing dual leads

33213

33230

Initial generator insertion or replacement plus insertion of dual lead

33208

33249

Removal generator with replacement generator only dual lead system

33228

33263

Removal of electrodes-dual lead system

33235

33244

Upgrade single lead system to dual lead system

33214 (includes removal of existing generator)

33241+33249

Insertion or replacement of temporary electrode

33211

Multiple Insertion multiple lead without generator

33217+33224

33217+33224

Initial pulse generator insertion only with existing multiple leads

33221

33231

Initial pulse generator insertion or replacement plus of multiple leads

33208+33225

33249+33225

Removal generator with replacement generator only multiple lead system

33229

33264

Removal of pulse generator only (without replacement)

33233

33241

Removal and replacement of generator and electrodes

33233+(33234 or 33235)+(33206 or 33207 or 33208) and 33225 when appropriate

33241+33244+ 33249 and 33225 when appropriate

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THE MEDICAL BUSINESS JOURNAL April 2012

Join the Medical Management Institute as we embrace an exciting new educational platform on Learner Nation! Courses and certifications online now in one convenient location. For a limited time, complete any available certification course through Learner Nation and receive $200 back for completing a survey to help us continue to improve this revolutionary learning system! To sign up or learn more, call the Medical Management Institute at 866-892-2765

ICD-10 Delay Compliance date: October 1, 2014 HHS has proposed a rule for a one-year delay in the compliance date for the ICD-10 diagnoses and procedure coding system. New deadline: October 1, 2014 Why the delay? Version 5010 needs to be implemented first for providers to be able to start using ICD-10. With this new standardized health claims form for electronic health transactions has come its own difficulties with implementation. Along with this, physicians needs more time to prepare. To educate an entire staff on 68,000 diagnosis codes compared to the 13,000 in ICD-9 along with the 87,000 in-patient procedure codes compared to 11,000 in ICD-9 is a huge endeavor, not to mention a large financial undertaking. AMA estimates the cost 6

of IDC-10 implementation for each organization to range anywhere from $83,290 to over $2.7 million. This includes everything from education and coder training to software and testing with payers. Aren’t there any alternatives? Other than keeping the deadline at its original extension, October 2013, there was a proposal to completely skip ICD-10 and wait for ICD-11. However with this came its own problems. ICD-11 is not expected to be released by the World Health Organization until 2015 at the earliest, and this would only be a basic version. Also, a transition from ICD-9 to ICD-11 would, without a doubt, be a much more difficult transition than ICD-9 to ICD-10. According to the World Health Organization, “...it would be more difficult for [the] industry and it would take anywhere from 5-7 years for the United States to develop its own [ICD-11 version].” Not only would this be more difficult, but it would penalize the organizations that have been working hard and making progress with their ICD-10 transition. Importance of ICD-10. With the expanded codes and additional details, ICD-10 will allow, according to CMS, “greater analysis of clinical and treatment data and will help to reduce fraud and improve accuracy in reimbursements.” With this inevitable transition, delayed or not, one must be educated in order to keep up with this ever-changing healthcare industry. If you are interested in in a live ICD-10 training event, MMI is hosting CoderWeek in Alpharetta, GA June 12-16, 2012. Two days will be dedicated to ICD-10 training worth 14 CEUs accepted by both AHIMA and the ARHCP. Visit mmiclasses.com/land/coderweek.html to register online, or you can call MMI at 866-892-2765 extension 214.


“Thank you for being there when I have questions.” - Kim D. McKinney, TX

Q: A:

In hospice care, if a Dr. who is NOT the admitting physician sees a patient, do you add GV as the modifier? The short answer to your question, assuming that when you use the word 'admitting physician' that you are referring to the 'attending physician', is YES! You should either append the GV or GW modifier in conjunction with either "Q5" or "Q6" modifier when submitting claims for services provided to a hospice patient by a physician other than the attending physician. The best resource for information on billing Medicare Part B for hospice is your State's Part B Intermediary, which can be found on CMS.gov. [Direct Link: http://go.cms.gov/II7Uqg]

Q: A: Q: A:

Which set of EM guidelines is better?

THE MEDICAL BUSINESS JOURNAL April 2012

Coding Corner

There has been a lot of confusion about which set of guidelines is better for physicians. It's hard to say which set of rules is "better" because each version has advantages and disadvantages. Typically, the 1997 guidelines are used more frequently than the 1995 guidelines. Unfortunately, you are going to have to choose to use one or the other. It is NOT ACCEPTABLE to mix and match elements from both sets of rules. When everything is taken into consideration, we advise physicians to use the 1997 EM guidelines. 

When do I use the 1995 EM Guidelines, and when do I use the 1997 Guidelines? To ensure you are submitting claims correctly, check with your local Medicare carrier for any specific requirements that they may have regarding the use of 1995 vs. 1997 EM guidelines. Second, sit down with your physician and compare how the two versions treat the key components of documentation, decide which version you and your physician feel most comfortable with, then simply continue to use that specific set (1995 or 1997) for all claims from there on out. Do not alternate between the two sets of guidelines!

“The best resource for information on billing Medicare Part B for hospice is your State’s Part B Intermediary…”

Please feel free to submit your coding questions to the instructor team at instructor@mmiclasses.com.

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Medical Management Institute presents

CoderWeek LIVE in Atlanta! Part 1: Coding Certification Boot Camp • Intensive 3 day coding prep course for CPC exam • Supplemental online materials and practice exam provided • $1099 or $1499 with iPad

When: June 12-16, 2012* Where: Preston Ridge Medical Campus in Alpharetta, GA

Part 2: ICD-10 Training • 2-day seminar worth 14 CEUs • AHIMA training workbook and ICD-10 codebook included • $599 or $999 with iPad *Can’t make it to the live event? The entire CoderWeek will be recorded and available online!*

Spaces are limited-REGISTER TODAY! mmiclasses.com/land/coderweek.html 866-892-2765

Sign up for the entire CoderWeek before May 21st and receive a $50 Gift Certificate! [Terms and Conditions Apply]

THE MEDICAL BUSINESS JOURNAL The Medical Management Institute 3330 Preston Ridge Road, Suite 380 Alpharetta, GA 30005


April 2012 Medical Business Journal  

April 2012 Issue 3 Volume 3

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