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By: Sheila Green-Shook, RHIA WSHIMA President 2010-2012


Happy Spring!

INSIDE THIS ISSUE President’s Message WSHIMA Annual

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Meeting - Your CDQ WSHIMA Annual


Meeting—Success Cue the Drum Roll


Lucy Hay Scholarship


Director’s Report

Hope you all have had an opportunity to be outside and enjoy some of the great weather we have been having on the weekends. Speaking of great weekends, a big ‘THANKS’ to everyone who attended the WSHIMA annual meeting April 19-21 at the Sea-Tac Marriott. There were great speakers and vendors, and a good time was had by all. Many thanks to the following who worked hard: 

Education Committee: Gwen Hughes – Chair, Betty Doyle, Rik Lewis, Sally Beahan, Jackie LaRue, Kathy Peterson, and Sheila Green-Shook.

Annual Program Committee: Kathy Martin - Chair, Lisa Withers, Marci Vanderbosch, Joyce Duffy, and Sheila Green-Shook

Silent Auction: DeeDee Adams, Amy Bledsoe and Carol Quinsey for her beautiful quilt!! (please see Directors article)


Chief Delegate’s Report


Why Implement ICD10?




Modifier Muddle


Our meetings cannot be successful without the support of our members, as well as, our vendors!

Calendar of Events


WSHIMA Mission & Values


So what has the 2011 -2012 Board been doing this year?

WSHIMA Board Members & Committee Chairs


Delegates attended Summer Team Talks/Leadership – July, 2011

WSHIMA applied for and received 2nd place 2011 CSA Core Service Achievement award at STT for CE program related to HIM Practice Topics

Delegates attended House of Delegates, Salt Lake City, October, 2011 Next Page

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Delegates attended regional meetings to provide WSDHIMA/AHIMA updates

Finalized contract to provide ICD–10 training to members and non-members— January, 2012

Coding roundtable – February, 2012

Negotiated with AHIMA to provide ICD-10 Coding Academy in Seattle — March, 2012

2 Delegates attended Winter Team Talks/Hill Day - March 2012

Moving forward with ICD-10

Implementation of a unique patient identifier

Future of Healthcare Conference—March, 2012

First co-sponsored event involving 7 local chapter organizations

Evaluated proposal to create a new regional state chapter – PCHIMA (Pacific Coast)

Evaluated the creation of a WSHIMA facebook page and twitter

This is my last article for the EB as your President and I want you all to know that it has been my honor and privilege to serve in this role for the past two years!

3 WSHIMA Annual Meeting – Your CDQ By Sally Beahan, UW Medicine & Rik Lewis, Moss Adams

The Coding and Data Quality Committee (CDQ) supported the Annual Conference by arranging speakers on various topics. The speakers included Dr. Zielske from ZHealth who hosted a coding roundtable for Interventional Radiology. Dr. Z spent nearly two hours on IR coding and he could have done another 2 hours. Dr. Z also gave away a couple of his books for participating! HIM Panel discussion on coding which included 4 of our local HIM experts (Kay AndersenNorthwest Hospital, Carey Roach-Franciscan, Corinne Meyer-Harborview/UW Medical Center, and Lara Brossard-Swedish). The panel provided a great insight on the present and future challenges presented in the coding committee and how to stay ahead of the curve! ICD-10 Assessment Tools by Melanie Endicott included actual assessment results from volunteers to give us some insight of the challenges ahead with ICD-10. Not only did Melanie get AHIMA to donate the tools, but she also gave away 10 ICD-10 pocket books! Beverly Ireland gave us an update on her efforts to create a “Culture of ICD-10” at Evergreen Medical Center and the tools she utilizes to prepare for her team for ICD-10. Peggi-Ann Amstutz from Moss Adams helped us work through the “modifier muddle” for our Pro-Fee coding roundtable. Gloryanne Bryant offered a keynote on the future of HIM and she was kind enough to provide a break out session on Computer Assisted Coding. The CDQ thanks all our wonderful speakers! Next step for CDQ is to schedule a coding roundtable this Fall in Eastern Washington.

4 WSHIMA Annual Meeting – Success! By Amy Bledsoe WSHIMA would like to thank all those who make the 2012 Silent Auction a tremendous success. This year we had 45 items donated and $2744.00 was raised. All the money earned will be used entirely for Scholarships and Professional Development for WSHIMA members. The auction would not have been a success if it wasn’t for the wonderful members who donated items and those who placed the highest bid. The following is a list of those members. Donators: 3M, Amy Bledsoe, Ann Armstrong, Anne Blackburn, Becky Rios, Bill Thieleman, Carol Quinsey, Dalin Pel , DeeDee Adams, Evelyn Ferrier, Gwen Hughes, INHIMA, Jeremy Doyle, Jill Burrington-Brown Joanne Liantonio, Joyce Duffy, Julie Hardy, Kathy Lange, Kathy Martin, Lorena Crosasso, Lynette Colis, Marci Vanderbosch, Mary Bloomsburg, Mary Meek, Mary Rausch-Walter, MedAssets, Melanie Endicott, Merida Johns, Nick Fisher, Reimbursement Management Consultants Inc., Schick Shadel Hospital, Seattle Airport Marriott, Sheila Green-Shook, SHIMA, Spokane Community College, Susie Sterne, TAHIMA, and Teri Wiseman. Highest Bidders: Amy Bledsoe, Bill Thieleman, Carol Quinsey, Clemente Salazar, DeeDee Adams, Diane Sandvic, Erin Ussery, Ginette Bailey, Gwen Hughes, Janet Muenzenberger, Jeremy Doyle, Jill Sjolin, JoAnne Liantonio, Joe Hemion, John Goldman, Joyce Duffy, Julie Hardy, Kathy Backstrom, Kathy Martin, Kathy Peterson, Leslie, Barich, Lisa Withers, Liz Gonzalez, Marci Vanderbosch, Maria Washington, Merida Johns, Melanie Endicott, Pam Beattie, Rik Lewis, Shannon Huffman, Sheila Green-Shook, Sherri Pierson, Terri Hall, Tina Saramzadeh, This year there was a random drawing for $25.00 for each item an individual or group donated to the silent auction. Congratulations to the winners: Gwen Hughes, INHIMA, and TAHIMA.

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5 WSHIMA Annual Meeting – Success, cont’d WSHIMA tried something new at the conference; we had a beautiful quilt handmade and donated by Carol Ann Quinsey. WSHIMA members attending the conference had a chance to purchase tickets. The quilt was raffled off and 100% of proceeds will be used for Scholarships and Professional Development for WSHIMA members. The quilt auction generated $1,035. Congratulation to the winner, Jenny Lee.

Start thinking of auction items that can be donated for next year; let’s make the 2013 silent auction bigger and better.

6 ATTENTION: Cue the Drum The Seattle Health Information Management Association (SHIMA) would like to invite you to visit our new and improved website at We launched the new site in April of this year and have been growing the content over the past few weeks. We think you will notice a new look and feel to the refined website. All of the same great information and resources will still be there, but we have included additional elements to the site, such as:

Blogging Capability

Job Board

SHIMA events

HIM community event calendar

Historical Page (soon to come)

Please take a moment to visit the site. If you have any comments or suggestions for our website please let us know by emailing us at Additionally we would like to welcome you to join SHIMA as a member and/or volunteer. We have many exciting things going on and we would love to get more folks involved. If you would like to find out more about SHIMA please visit our fantastic new web site or drop us an email, we certainly would love to hear from you! Come get involved! Jeremy Doyle, RHIA, CHPS President, Seattle Health Information Management Association

7 “Congratulations to Jeremy Tibbs and Jessica Oda, recipients of the Lucy Hay Scholarship on behalf of SHIMA!” By Kathleen Nguyen, RHIA Jeremy Tibbs is completing his Post-Bachelorette Certificate in Health Informatics and Health Information Management at the University of Washington. He has a strong passion for information technology and implementation. He plans to work in a cross functional position in HIM, with responsibilities in IT and health information. In his spare time, he volunteers for the Real Change Homeless Empowerment Project. Jessica Oda is completing her Bachelor’s degree in Health Informatics and Health Information Management at the University of Washington. She intends to pursue a career in Compliance or Quality Assurance. During the past four years, she has worked at UW School of Medicine, in the Inflammatory Bowel Disease Research Program. She is recognized among co-workers and colleagues for her high work ethic, leadership skills, professionalism and dedication.” I also wanted to mention on a personal note that the selection this year was a difficult one. Shoreline Community College student applicants’ were stellar and I wanted to let you know you have a great group students. The scholarship committee is brainstorming ways to give out more scholarships by next year and want to thank you for your help!

8 Director’s Report By DeeDee Adams, RHIT 2012 Sister Peter Olivaint Scholarship WSHIMA is pleased to announce the awarding of six Sister Peter Olivaint Scholarships to the following students: Shannon Kinnaird-Armstrong, Mia Norheim, Seifu Alemu, Nadia Palama, Joan Graham, and Nancy Skrei. Each student received $500.00. Application for the 2013 Scholarships will be available this November. To qualify, the applicants must: 

Be WSHIMA Student Members

Be Students in their final year of the program

Possess cumulative grade point averages of no less than 3.0 on a 4.0 scale

Demonstrate dedication to the profession

Students are asked to write an article explaining how the scholarship will help the recipient pursue their HIM degree. Shannon Kinnaird-Armstrong, student at Spokane Community College To the WSHIMA organization, I am thrilled to accept one of the Sister Peter Olivaint Scholarships. While working on my degree in Health Information Management, I have been working full time at Providence Sacred Heart Medical Center and have found that balancing these two demands, along with a family has been very challenging and energizing at the same time. Cost of tuition has been a burden and this scholarship will assist me in covering my Spring quarter tuition costs, clinical fees, RHIT exam and books as I finish my final quarter in the Health Information Management program. My mother, Marguerite Miller, was an LPN who went back to school and received this same scholarship in 1989, as she completed her degree in Health Information! She was able to blend her nursing background and Health Information education and worked at Kootenai Medical Center for twenty years in a utilization review management role. It is so fun to see how many ways a degree in Health Information can be used. She was thrilled to hear that this scholarship continues to be offered to students and was very happy that I was granted one of the Next Page…... Next Page scholarships.

9 Director’s Report, cont’d I am so grateful and thankful to have a professional organization like WSHIMA which rewards up and coming professionals for commitment to their career field and recognizes academic achievement! I want to thank the WSHIMA Board of Directors and the Advocacy/Legislative Committee for my favorite on the job tool of the WSHIMA Legislative Manual. This tool has been a blessing to our organization and myself, as we work to accurately release patient information and continue to protect health information! Thank you to the WSHIMA organization and all of the volunteers who support the Health Information Management field! Shannon Kinnaird- Armstrong Mia Norheim, student at Tacoma Community College Being selected for the Sister Peter Olivaint Scholarship has made such a positive impact on my education. Not only in helping to ease the financial burden of going back to school, but also by giving me the confidence and motivation to move forward. It is so encouraging to know that there is support from the field standing by - ready and willing to help me achieve my educational goals - and to know that this same support will undoubtedly be there for me in the future as a professional. This scholarship has really cemented the fact that this career change was the right decision. I can now move forward without wondering where I’m going to find the money for textbooks and concentrate on what’s really important: my education. I cannot thank WSHIMA enough! -Mia Norheim Seifu Alemu, student at Shoreline Community College THANKS WSHIMA I have received the Washington State Health Information Management, Sister Peter Olivaint Scholarship award of the year 2012. I am thankful for the assistance in my educational endeavor. In addition to the financial help, this scholarship encouraged me to be better student and professional. I am proud to be a member of WSHIMA, and will also participate actively in the association. I am also thankful for all of my Shoreline Community College Health Information Management directors and instructors. I know for sure that it is also by their guidance and attention to my studies that I became a good student. Sincerely, Seifu Alemu, SCC, HIIM student

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10 Director’s Report, Cont’d Nadia Palama, student at Shoreline Community College My name is Nadia Palama and I am a 2nd year student in the Health Informatics and Information Management Program at Shoreline Community College. I am very honored to be selected as a recipient of the Sister Peter Olivaint Scholarship award this year. This scholarship award will help me purchase the necessary study materials, current coding books, and pay for the RHIT exam that I plan on taking before June. This scholarship award also brings me a little closer to my goals of obtaining my Associates degree in Health Informatics and Information Management this Spring, becoming an RHIT, and furthering my education by pursing my Bachelors degree in Health Informatics at Western Governors University in the Fall. The past two years have been an incredible journey for me. I cannot wait to get out there in the world and apply my knowledge and skills that I have acquired in the Health Information Management program at Shoreline. Thank you! Nadia Joan Graham, distant learning student of the University of Cincinnati Dear WSHIMA Family, I am very excited to receive one of the Sister Peter Olivaint Scholarships. I must say, when I was notified I literally jumped up and down expressing my joy, I rarely win anything. Looks like my luck has changed! The monies I’ve received have already been applied toward my student loan. As we, all know they can build up pretty fast. This scholarship is helping me achieve my goal of graduating from the University of Cincinnati Health Information Management program with a bachelor’s degree in HIM. Soon after graduation this August, I will pursue my RHIA degree. I strongly believe that when the time is right our dreams will be fulfilled. Another dream of mine is to become a Health Care Manager within the Department of Corrections. Many changes are happening and I believe that people of our caliber need to be where the action is to ensure programs head in the right direction. Becoming a RHIA has been a dream of mine for quite some time and by the end of this year I will be one! Thank you again for this wonderful present! Joan Graham


Medical Records Supervisor Coyote Ridge Corrections Center

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11 Director’s Report, cont’d Nancy Skrei, student at Spokane Community College I want to thank the WSHIMA scholarship committee for this incredible opportunity that was afforded to me through the Sister Peter Olivaint scholarship. I am in the last year of the program and will be using the scholarship money toward my tuition. Currently, I find myself on a new path in life with a new career on the horizon of which I am very excited. My son also started college this year so we are both pursuing more education and this money will help out considerably. I have been attending the program at Spokane Community College and have been inspired by the faculty as well as the other students in my program. I am excited to be entering a growing and thriving profession and one that contributes to the overall good. It is wonderful to be involved in a profession that has a strong professional association on a regional, state and national level. I look forward to participating fully in my professional association and gaining more knowledge through continued education as the years go by. I think that the involvement of WSHIMA in supporting students pursue their education is so commendable. I will be taking my RHIT exam this summer and hope to be employed in the field. Thank you so much for this opportunity. Nancy Skrei Health Information Technology student Spokane Community College ++++++++++++++++++++++++++++++++++++++++++++++++++++ 2012 Professional Development Award WSHIMA is pleased to announce the award of the 2012 Professional Development Award to Dalin Pel. Dalin is a current student in the Executive Master’s in Health Administration program at the University of Washington. This scholarship is awarded yearly to give qualified, credentialed members in good standing the opportunity to pursue professional development. Application for the next Professional Development Award will be available next year.

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12 Director’s Report, cont’d The Exam Reimbursement Award The Certification Exam Reimbursement Award, which is a drawing, will reimburse the AHIMA RHIA or RHIT exam cost for up to 18 new health information administration and technical graduates who take and successfully pass the national AHIMA credentialing exam. Up to nine member applicants are drawn in November and again in May. In order to qualify, each applicant must complete the drawing application which is available at The next Exam Reimbursement drawing will be held this month (May 2012). +++++++++++++++++++++++++++++++++++++++++++++++++++++++

WSHIMA is proud to support these programs and appreciates our member support as well. Whether through donations to the Scholarship fund, donating an item to the annual Silent Auction, or making a purchase at the Silent Auction, your support is what makes the programs successful.

13 Report on Winter Team Talks 2012 By Bill Thieleman, RHA, CHP WSHIMA, Chief Delegate Winter Team Talks 2012 took place in Washington, DC on March 26, once again piggy-backed with Hill Day. Sheila Green-Shook, 2012 WSHIMA President; Bill Thieleman, Chief Delegate; and Jill Burrington-Brown, AHIMA Director took part in both events. Patty Thierry Sheridan, 2012 AHIMA President, kicked off the meeting which was attended by delegates from across the country as well as approximately 80 delegates attending via Webex. Lynne Thomas Gordon, AHIMA Chief Executive Officer, shared how the AHIMA board and staff have been addressing current issues and goals including a nimble response to the delay of ICD-10, a project that focuses on informing employers about the contributions of HIM professionals to health care, successfully beating the 2011 budget, and a new “Learn more, earn more” campaign. The AHIMA Foundation’s The Council for Excellence in Education (CEE), a council of educators responsible for determining strategy, is exploring an RHIA executive track for qualified uncredentialed members, identifying areas of specialization for associate degree curricula and investing in faculty development in the areas of research and data integrity in governance.. AHIMA staff members are also currently engaged in a program of team building, cross-functional training, enhanced communication and expanding employee satisfaction. Lynne shared that CAHIIM currently has 50 schools in the process of accreditation. At this point in time, there are 237 associate degree programs, 53 baccalaureate programs, and six master’s level programs accredited by CAHIIM. The 2012 AHIMA ballot was announced as: 

President/Chair-Elect (Vote for One)

Diann H. Brown, MS, RHIA, CHP, FAHIMA (TX)

Angela Kennedy, MEd, RHIA, CPHQ (LA)

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14 Report on Winter Team Talks 2012, cont’d Directors for the Board of Director (Vote for Three) 

Susan W. Carey, RHIT (KY)

Kerry Frances Costa, MS, RHIA (FL)

Pawan Goyal, MD, MHA, PMP, FHIMSS (TX)

Karen Grant, RHIA, CHP (MA)

Dana McWay, JD, RHIA (MO)

Laura Pait, RHIA, CCS (NC)

Danielle Reno, MHA, CCS, CCS-P, CHC (CA)

Charlie Robinson, RHIT, CCS-P (FL)


The Candidate CoP is open May 21 through June 1 and voting will be June 4 to June 22. Your delegates urge you to take an active part in determining AHIMA leadership by taking the time to read about the candidates, ask questions and vote. Glorianne Bryant discussed AHIMA’s position on ICD-10, indicating that members are urged to voice concerns actively. Members are encouraged to visit the AHIMA Action Center of the Advocacy Assistant which will help facilitate letter writing. The association is urging all HIM educators to send letters to HHS Secretary Kathleen Sebelius, and the CMS Acting Administrator Marilyn Tavenner. Also available is AHIMA’s “Ten for 10” resource which lists the reasons why we need to continue to move forward with ICD-10. The long-awaited and much-anticipated notice of proposed rulemaking detailing the requirements for Meaningful Use Stage 2 was published in the end of February by the Centers for Medicare and Medicaid Services (CMS). The rule was published in the Federal Register March 7, with a 60-day comment period. The rule identifies HIT measures that have moved to the core set of measures and new menu set measures, new clinical quality measures, and options for measure reporting. Further details on the proposed rule and analysis are available on the Journal of AHIMA Website. Next Page

15 Report on Winter Team Talks 2012, cont’d To heighten the profile of the profession and create awareness, AHIMA is launching the AHIMA Grace Award. Named for AHIMA’s first President, Grace Whiting Myers, this award will recognize healthcare delivery organizations that exemplify H-I-M excellence and innovation. The first recipients will be announced at the 2012 Annual Convention, and we encourage you to consider supporting the effort by nominating your employer. More information will be coming on this award. Members from the Practice Council: Consumer Health met to update the myPHR site. The site was refreshed and content added in time for the HIMSS meeting. In the last year, the site received over 100,000 Visits, over 93,000 Unique Visitors; 400,000 plus Pageviews; and an average 3.3 Pages viewed per Visit. Data Governance was discussed as an area we need to be aware of and knowledgeable in as more and more data will be available. The HIM profession has already begun to shift focus and direction from the management of information to the governance of information -- a concept known to many today as Information Governance (IG). The consensus among the leaders today is that IG encompasses the management of both structured and unstructured data content with general agreement not only about what IG is, about what its principal components, which include: records management, e-discovery, archiving & storage, privacy & security, compliance and risk management. A 2008 Rand study found that 8-14 percent of all health records have patient-data mismatch errors. Preventing and correcting those errors is also a huge healthcare costdriver. Absence of a patient-data matching strategy results in duplicate records, incomplete and fragmented information, billing problems, increased fraud and abuse, security problems and quality of care issues. A Coalition for a Patient-Data Matching Strategy has been formed to move forward with national patient identifier which will support health information exchange, coordination of care, patient safety, identity theft prevention and fraud detection. Joining AHIMA in the coalition are American Medical Informatics Association (AMIA), Association of Medical Directors of Information Systems (AMDIS), College of Health Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS) and others.

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16 Report on Winter Team Talks 2012, cont’d During lunch, delegates heard from David Muntz, First Deputy of the Office of the National Coordinator. David led with a statement of the significant role of Health Information Management in implementation of EMRs and the advent of health information exchange. Your chief delegate suggested that a statement to that effect from the ONC could have a positive impact on the quality of EMR projects across the United States by helping organizations distinguish between implementation of software and implementation of legal medical records. Much of the afternoon was spent with Glenn Tecker, who has been providing the board and senior staff with valuable assistance in reorganizing how AHIMA does business in light of bylaws and changes passed by the House of Delegates in October 2011. Glenn led delegates in an exercise that helps corral the complex combination of demographic, political, legislative, business and technology trends that the association must grasp and navigate. Under the bylaws changes, the board’s high level responsibilities include setting organization direction, ensuring necessary resources and providing oversight. Relevant to the House of Delegates role as governing the HIM profession, an interesting discussion of HIM “mega-issues” was presented. Each mega-issue has recommendations and action plans which foster AHIMA mission and HIM. Content from the Powerpoint slides will be posted on our WSHIMA CoP shortly. Your representatives had spent the previous day, on their own “dime” of course, exploring the nation’s capital and so they had been happy to spend Team Talks day sitting. However, by the end of a very long day, other body parts were as insulted and sore as their feet had been from sightseeing. Delegates retired to a modest reception to continue networking and discussion. Festivities ended early as most of the delegates were to meet the next morning for a 7:30AM breakfast kick-off for AHIMA Hill Day.

17 Why Implement ICD-10? By Mariamawit Yilma With the Oct. 1, 2014 deadline approaching, healthcare facilities across the U.S. are currently undergoing training in preparation for the implementation of the International Classification of Diseases, Tenth Revision (ICD-10). On January 16, 2009, the US Department of Health and Human Services (HHS) mandated the replacement of ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 code sets. According to the American Medical Association (AMA), covered entities, defined in the Health Insurance Portability and Accountability Act (HIPAA) as health care providers, including physicians, payers and clearinghouses are required to comply with the regulation. However, due to the intensive training and costly process of implementing ICD-10, many organizations are still questioning the need for the transition. Even though the implementation of ICD-10 poses a burden on healthcare facilities, this transition is imperative for our healthcare system. ICD-9-CM, abbreviated for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM,) was named as the code set for reporting diagnoses and hospital inpatient procedures in electronic administrative transactions by HIPAA in 2003. Since its mandated use by healthcare facilities, ICD-9 has served as an effective tool for the classification of patient morbidity and mortality. However, as we make new technological and medical advances, it is essential that we have a coding system that complies with our current findings. ICD-9, developed in 1978, has become outdated due to its lack of codes that accurately reflect all advances in medical technology and knowledge. According to the AMA, ICD-9 codes are divided into chapters based on body systems. Over the past three decades of using the ICD-9-CM system, the more complex body system chapters have run out of codes. The lack of codes within the proper chapter has resulted in new codes being assigned in chapters of other body systems. For example, new cardiac disease codes may be assigned to the chapter for diseases of the eye. The rearrangement of codes makes finding the correct code more complicated. Additionally, ICD-9 lacks the specificity ICD-10 offers. The new additions in ICD-10 are projected to improve public health tracking of diseases and other threats, even acts of bioterrorism that might otherwise go unrecognized. According to the AMA, more precise codes also have the potential benefit for: 

Fewer rejected claims

Improved benchmarking data

Improved quality and care management

Improved public health reporting

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18 Why Implement ICD-10?, cont’d In addition, the specificity of ICD-10 allows for detailed tracking of health-associated conditions, more precision in reporting complications, and more detailed data on injuries or accidents. With these improvements, healthcare facilities will be able to provide improved quality of care for patients while also reducing healthcare costs. To prepare for the implementation of ICD-10, affected parties (providers, payers, clearinghouses) must start strategizing for the upcoming changes. The CMS recommends that providers develop an implementation strategy that includes an assessment of the impact on their organization, a detailed timeline and a budget. Payers should review payment policies since the transition to ICD-10 will involve new coding rules and clearinghouse should have products and services in development that will allow payers and provider to fully implement ICD-10 by October 1, 2014. Sources "ICD-10 Implementation." Centers for Medicare & Medicaid Services. Feb. 2012. Web. Feb. 2012. Ullman, Kurt. "ICD-10 to Bring Big Changes: Learn How to Prepare for the New Coding System." ENT Today, Dec. 2011. Web. 02 Mar. 2012. "American Medical Association - ICD-10 101: What It Is and Why It’s Being Implemented." American Medical Association, June 2010. Web. Feb. 2010.

19 Announcements Triumph Awards The AHIMA Triumph Awards have honored those professionals responsible for advancing the field of health information management (HIM). Each year, AHIMA members nominate those that have demonstrated extraordinary leadership, volunteerism and talent. As part of a long and cherished tradition, the Triumph Awards continue to be the highest recognition of excellence, dedication and service, and are presented annually at the AHIMA Convention & Exhibit. Nominations will be accepted through June 1, 2012, for recognition in 11 award categories. Nominees must be AHIMA members or corporate sponsors (see nomination guidelines for rules and exceptions). For additional information, please go to: http://

In Memory of Judith May, RHIA Judi died suddenly on March 10, a victim of a car-pedestrian accident while vacationing in Scottsdale, Arizona. She was 68 years old and would have become 69 on Easter Sunday, April 8. Judi graduated from Seattle University/Providence Hospital School of Medical Record Science in August 1965. Soon after graduation she secured the position of Director of Medical Records at Providence Hospital, Seattle, a position which frequently was filled with fairly new graduates during those years. She moved to Bainbridge Island and was married and raised three children, and now was enjoying her 3 grandchildren. She began doing Long Term Care facility and specialty facility consulting while raising her children. After becoming an empty nester, she returned to hospital work, doing coding at Swedish Hospital for many years. Recently she became the Coding and Reimbursement Specialist for a clinic in Silverdale, nearer to her home. Judi was a very competent, dedicated professional in all respects. She loved her work, was supportive of WSHIMA and the educational programs in Washington, and was an all-around champion for the profession. She will be greatly missed.

Ingrid Bentzen Classmate and friend of Judi.

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20 Modifier Muddle: Recap of Questions and Responses from the April 2012 WSHIMA Coding Roundtable Presentation by Peggi Ann Amstutz, MBA, CCS-P, CCS AHIMA-Approved ICD-10-CM/PCS Trainer During last month’s Professional Fee Coding Roundtable discussion we had some lively conversation surrounding several of the modifiers. They were also several questions presented after the close of the presentation which the membership may benefit from. In particular we had several questions related to Modifier 22. Modifier 22: Can this be used for ‘patient’ choice? Let’s revisit the purpose of Modifier 22. Per CPT4© Modifier 22 is defined as “Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, and severity of patient's condition, physical and mental effort required)”. One of the questions asked was ‘if the physician uses this technique 70% of the time, is it really unusual or substantially greater’? CPT4© states in the Surgery Guidelines under special report, “A service that is rarely provided, unusual, variable or new may require a special report”... “pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.” Where does this leave the coder? Hopefully armed with enough information to make a decision and help develop a coding policy for this coding situation

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21 Modifier Muddle: Recap of Questions and Responses from the April 2012 WSHIMA Coding Roundtable Presentation, cont’d As the surgical standards continue to change with technology, the surgeon’s efforts may increase or decrease. As a reminder, the RVUs associated with CPT4© codes are averages (time, resources etc) for each procedure as they recognize not every case is the same. Where coders struggle is when there appears to be a ‘wholesale’ shift in procedure documentation. Doing a web search to see what policies exist for best practice, we found some very interesting policy statements by payers: Modifier -22 is not appropriate for use in the following circumstances: 

If the sole purpose for use of the modifier is for a complication due the surgeon’s choice of approach.

Before payment of a claim “We routinely ask medical professionals to submit clinical records before we pay a claim if the claim includes: 

A code appended with Modifier 22 (unusual procedural service), for example, an operative report for surgical procedures or office notes for non-surgical procedures”

Noridian Medicare included a warning of the modifier 22 use: "Avoid routine use of the 22 Modifier. This Modifier should be used only when a surgeon provides a service that is greater than usually required and is unable to report a secondary code that would claim the additional work. The use of specialized technology (for example, a laparoscope or laser) does not automatically qualify for use of Modifier 22. Abuse of the Modifier will attract unwanted scrutiny. Repeated misuse could trigger an audit." Next Page

22 Modifier Muddle: Recap of Questions and Responses from the April 2012 WSHIMA Coding Roundtable Presentation, cont’d This direction from Noridian appears to address the situation where a provider uses modifier 22 greater than70% of the time when performing a procedure. If used that often, it appears to fall into routine use. CMS offers the following information in §20.4.6 of the Medicare Claims Processing Manual: The fees for services represent the average work effort and practice expenses required to provide a service. For any given procedure code, there could typically be a range of work effort or practice expense required to provide the service. Thus, carriers may increase or decrease the payment for a service only under very unusual circumstances based upon review of medical records and other documentation. In summary, each practice or facility should have a Coding Policy in place which outlines when it is appropriate to append modifier 22 to a CPT4© code. The policy should include examples as well as identify a regular monitoring process to analyze the modifier’s usage with specific codes. The practice or facility should develop a procedure to proactively approach the CPT Advisory Panel if new technology is leading to substantially different surgical times outside of the threshold determined in the existing code set(s). References:



May 18-19, 2012

UW ICD-10-CM Coding Workshop

8 AM—5 PM

Bellevue, WA

May 19, 2012

TAHIMA—Ultimate Saturday Workshop

9:30 AM

Tacoma Community College

June 2, 2012

17th Annual TCC Leadership Conference

8 AM—4 PM

Tacoma Community College

August 8, 2012

INHIMA Meeting Deaconess Health and Education Building Spokane, WA

September 15, 2012

INHIMA Fall Workshop TBD

November 14, 2012

INHIMA Meeting Deaconess Health and Education Building Spokane, WA

May 2-4, 2013

2013 WSHIMA Annual Meeting The Davenport Hotel

Additional information of above can be located at

24 A code of ethical health information management practices

Advocates public policy that advances HIM practice

The public’s right and high-quality health information

Provides career, professional development and practice resources

The celebration and promotion of diversity

Facilitates achievement of standards and provides education opportunities

Innovation and leadership in advancing health information management practices and standards worldwide

Facilitates member communication

BOARD MEMBERS WSHIMA President Sheila Green-Shook President Elect Gwen Hughes Past President Carol Quinsey

COMMITTEE CHAIRS INHIMA Representative Nancy Knight Education Legislative / Advocacy Betty Doyle Marsha Steele

Secretary Julie Hardy Treasurer Becky Rios

Coding & Data Quality Rik Lewis Sally Beahan Membership Donna Wilde Deb Jurgenson

2nd Year Director DeeDee Adams

2012 Annual Meeting Marci Vanderbosch

1st Year Director Amy Bledsoe

Evergreen Bulletin Gloria Anderson

Chief Delegate Bill Thieleman Delegate Marci Vanderbosch Delegate SHIMA Representative Jeremy Doyle TAHIMA Representative Kimberly Lee

History Bylaws Nominating Central Office Joyce Duffy


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