The Coders Call

Fall 2013, Issue 1

If in doubt, query the physician, remembering if not documented, not done. Without sufficient documentation, you cannot code, because documentation is the basis of all coding.

Whos Responsible?
The AAPCs code of ethics includes this statement, Know and respect existing federal, state and local laws, regulations, certifications and licensing requirements applicable to professional work. Wow. Know the regulations?! Most everyone agrees that coding and billing for the services you provide is now more challenging than ever. And most everyone agrees that they dont see things getting simpler; rather they believe things will become even more complex. So, is it really our job as coders to stay current on the ever-changing coding rules and regulations of payers? If it is, that makes it hard to keep up on proper coding to ensure full reimbursement and compliance. Is this where, Thats not my job! comes in? Knowing all of the regulations that govern health care these days can seem overwhelming. Doesnt it seem sometimes that somebody somewhere is overseeing almost everything we do? Many coding and billing professionals feel that they spend more time complying with rules that direct their work than actually doing the work itself. Does that sound like you?? Nevertheless, like it or not, as a healthcare professional, you have the responsibility (and duty as a coder) to keep up with the latest medical coding updates, rules and regulations. After all, coders are responsible for the codes submitted for billing, correct or

incorrect. And nobody wants to be accused, or even associated with, the f word Fraud! (However, it is possible for coders to be charged with fraud. Yikes!) A statement on the OIG Website, in a March 2013 AARP article, said , Fraud and waste are the Bonnie and Clyde of American health care, robbing the system of money that would be far better spent making sick people well. So, it is our job. Its our job to search out the latest regulations and apply them. Its our job to remain up to date on payer changes, coverage determinations and policies. Its our job to share this knowledge with others. Its our job to go over and above, to code and submit proper claims for payment, and to make certain that we strive to work ethically. Its our job to be the best!

Inside This issue

2 The Age Old Question: Is This a New Patient... Getting it right can help ensure that you get paid appropriately for your services and keep your practice audit-proof. Detailed Written Orders... Key points to the DME face-to-face requirements. 3 Who Me? A Coder? Have you ever thought becoming a coder? Theres no time like the present! Medical Review Signature Requirements. Understanding the acceptable phrases for electronic signatures.

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Detailed Written Orders and Face to Face Encounters CMS will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013. The written order for the DME must include, at a minimum: 1. The beneficiary's name, 2. The item of DME ordered, 3. The prescribing practitioner's National Provider Identifier (NPI), 4. The signature of the ordering practitioner and, 5. The date of the order. Key points of the requirement are: Documentation must show the physician, Physician Assistant (PA), Nurse Practitioner (NP) or Certified Nurse Specialist (CNS) had a face-to-face encounter examination with a beneficiary in the six months prior to the written order for certain items of Durable Medical Equipment (DME). DME ordered by a PA, NP, or CNS or a physician must document the occurrence of a face-to-face encounter by signing/co-signing and dating the pertinent portion of the medical record.

The Age Old Question: Is This a New Patient or an Established Patient?

Why does it seem we continue to wrestle with this question? The Recovery Auditors, under contract with the Centers for Medicare & Medicaid Services (CMS), are responsible for identifying and correcting improper payments in the Medicare Fee-For-Service payment process. The Recovery Auditors have identified claims with "New Patient" Evaluation and Management (E&M) services to have improper payments, because the new patient services have been billed two or more times within a 3year period by the same physician or physician group. The new patient CPT codes that will be checked in these edits include 99201-99205, 9932499328, 99341-99345, 9938199387, 92002, and 92004. The edits will also check to ensure that a claim with one of these new patient CPT codes is not paid subsequent to payment of a claim with an established patient CPT code (99211-99215, 99334-99337, 99347-99350, 99391-99397, 92012, and 92014). Quiz yourself to see how well you do below. 1. Patient John Doe is seen by Dr. Smith, an Internal Medicine physician on 9/12/13 for the first time. 2. John Doe returns to be seen by Dr. Smith on 9/25/13, but he was called away so his partner saw him. 3. John Doe is seen by the Neurologist in Dr. Smiths group on 10/1/13. 1. New, 2. Established, 3. New Go here for a short TMA article about new/established patients: http://www.texmed.org/Templ ate.aspx?id=5768

Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. Note that the G code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter. For more Information: http://www.cms.gov/Outreach-andEducation/Medicare-LearningNetworkMLN/MLNMattersArticles/Downloa ds/MM8304.pdf

Who Me? A Coder?

Have you thought about becoming a certified coder? The American Academy of Professional Coders is a national organization that offers a general certification exam and numerous specialty certification exams for coding on the physician/outpatient side. Check out their website. The address is www.aapc.com. (Click on the Certification tab.) The requirements for applying to take the exam are the following: a. 2 years practical coding experience b. If you do not have 2 years practical coding experience, you are qualified to sit for the certification exam if you have one year practical coding experience and 80 classroom instruction hours.

Medical Review Signature Requirements

Listed below are examples from Novitas Solutions of acceptable phrases for electronic signatures: Electronically signed by with providers name Verified by with providers name Reviewed by with providers name Signed by with providers name Signed: John Smith, M.D. with providers name This is an electronically verified report by John Smith, M.D. Authenticated by John Smith, M.D Authorized by: John Smith, M.D Confirmed by with providers name Electronically approved by with providers name Novitas expects the phrase/signature to be dated

With the application, you must submit two letters of recommendation verifying the number of instruction hours or amount of practical experience working in a coding capacity. The letters must come from a supervisor or previous supervisor. A letter may come from a teacher to verify classroom instruction hours. Upon passing the exam(s), you earn the title of Certified Professional Coder (CPC).
A membership fee to AAPC is also a requirement to take the exam. You must maintain membership with AAPC, plus submit 36 CEUs every two years to maintain certification. If you do not pass the exam on the first try, you can retake it again within one year for free. How can you prepare for the certification exam? Take Basic Medical Coding Take Intermediate Medical Coding Take a review course: o Our local AAPC Chapter also provides a review course for the certification exam. Contact the local chapter officers or Loretta Swan at lswa@tjc.edu for more information on dates/location of the review course. o Carol Buck, the author of your Step-by-Step coding textbook, works closely with AAPC. She has written a study guide called CPC PHYSICIAN EXAM REVIEW, THE CERTIFICATION STEP. This is the one I used. It contains two full-length practice coding exams with answers and rationale plus other helpful information for review. I felt very well prepared when I took the test, and after the test, I felt confident that I had passed which I did! The textbook can be purchased online at www.elsevierhealth.com. o AAPC offers an online study course that (Ive heard) is pretty good. AAPC only allows the standard or professional editions of the coding manuals ICD, CPT, and HCPCS. It is important to have the current year code books for the year the exam is taken. Please check out the website, and let me know if you have additional questions. Judy Young jyou@tjc.edu

Remember: Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable. For more information: https://www.novitassolutions.com/em/mr-sign-req.html

The Coders Call

Fall 2013, Issue 1

Are You On Track for ICD-10

Healthcare organizations and physicians have less than one year to implement ICD10!! Are you ready? Are you looking for a training tool? Why not check out this one produced by the World Health Organization? Go to: http://apps.who.int/classifications/apps/icd/ICD10Training/ICD10%20training/Start/index.html. If you are a paper person, you can also print the User Guide.

Important Timelines for the Sunshine Act

August 1, 2013 Industry will begin collecting data required by CMS January 1, 2014 Physician and Industry are able to register on CMS Open Payments website to receive information on reports when CMS releases for review June-August 2014 (Anticipate) Physicians will have opportunity to review consolidated individual reports and request correction September 30, 2014 First reports made public on CMS website

For more Information: http://www.amaassn.org/resources/doc/washington/sunshine-act-webinar-25april2013.pdf

The Coders Call

Attention: Loretta Swan 11538 Pecanridge Drive Tyler, TX 75703

Attention Coders!
Do you have submissions, photos, documents, stories, or other useful content to include in future editions that you would like to share? If so, send your information to: swanloretta@gmail.com for consideration in an upcoming newsletter.