Certification

Certification

Medical Coding Certification Details:

There are many organizations which are offering coding certifications.

Important certifications in Physician side and Hospital side practices

AAPC (American Academy of Professional Coders)

   It offers certifications, study guides,  local chapters throughout the USA and internationally and workshops

CPC                -           Certified Professional Coder

    CPC holders work in variety of settings, including Doctor’s offices.

    CPC holders will be tested on their knowledge of ICD-9-CM, CPT, HCPCS, Human Anatomy and Physician coding guidelines

    2 years of coding experience is required to sit CPC exams

CPC-H                       -           Certified Professional Coder - Hospital

   CPC-H holders may have variety of responsibilities including providing coding for outpatient hospital services

   CPC holders will be tested on their knowledge of ICD-9-CM, CPT, HCPCS, Human Anatomy and Hospital outpatient guidelines

   2 years of coding experience is required to sit CPC-H exams

Fee:

For CPC and CPC-H

Examination Fee: $300 for USA and other countries people

                                  $400 for Indians  
         

Membership Fee:

Individual membership: $120 for USA citizens

                                          $145 for Indians

Student membersip:  $70 for USA citizens

                                     $85 for Indians

Exam Information:

·        150 Multiple choice questions(Proctored)

·        5 hours 40 minutes to finish the exam

·        Open code books (Manuals)

·        One free retake     

Passing Score: 105/150

Website: www.aapc.com

AHIMA (American Health Information and Management Association)

            It offers Certifications, professional development courses, exam preparation material and audio seminars

CCS-P                        -           Certified Coding Specialist - Physician

   CCS-P  holders work in variety of settings, including doctor’s offices, clinics and similar settings

   CCS-P holders will be tested on their knowledge of ICD-9-CM, CPT, HCPCS, Vol.3, Human Anatomy and Physician coding guidelines.

CCS                -           Certified Coding Specialist

   CCS holders work in variety of settings, including Hospital settings.

   CCS holders will be tested on their knowledge of ICD-9-CM, CPT, HCPCS, Vol.3,  Human  Anatomy and Hospital coding guidelines.

Fee:

For CCS-P and CCS

Examination Fee: $ 299 (Member)

                                  $ 399 (Non-Member)

Membership Fee: $165

Exam Information:

Multiple Choice:  Correct answer = 1 point, Incorrect answer = 0 points

Multiple Select: Correct answers = 1 point (you have to select all right answers to get the entire question correct), Incorrect answers = 0 points

 Quantity Fill in the Blank (QFIB): Correct codes = 1 point (each code that you enter will be worth 1 point), Incorrect codes = 0 points

Passing Score: 300/400

Website: www.ahima.com

Certificate Maintenance:

   CPC or CPC-H Coder will be required to complete 18 continuing education units (CEU) per year

   CCS-P or CCS Coder will be required to complete 10 continuing education units (CEU) per year

The coder can earn in a variety of ways, including

·        Attending workshops

·        Attending seminars

·        Written an article or paper that is published, attending meetings of your local AAPC or AHIMA chapter and watching an informational video and preparing a summary

Interview Questions

Interview Questions:

1)     What is principle diagnosis?

a.      The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

2)     What is Modifier?

  

a.      To indicate that service or procedure that has been performed and has been altered by some specific circumstance but not changed in its definition or code.

3)     What is the common Modifier used in emergency?

a.      25 (Hospital and Physician Coding) and  27 (Hospital Coding)

4)     What is 62 Modifier?

a.      When two surgeons work together as primary surgeons performing distinct part of a procedure, each surgeon should report his distinct operative work by adding 62 modifier.

5)     Cerumen impaction?

a.      Cerumen impaction is a condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked.

6)     What are the basic guidelines of consultation?

a.      3 R’S are Request(By appropriate source like Physician or third party but not by patient’s request), Render(Providing service by consultant) and Report(The results of consultation has to be given) .

7)     What is DRG (Diagnosis Related Group) coding?

a.      DRG is a system to classify hospital cases into one of the originally 747 groups. These are based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of CC-complications or comorbidities&MCC-Major complication and comorbidity.

8)     What are the types of repairs?

a.   Simple Repair: Involving primarily epidermis or dermis, or subcutaneous tissue without significant involvement of deeper structures and requires one layer closure.

b.        Intermediate Repair: Require one or more of the deeper layers of the subcutaneous tissue and superficial fascia and heavily contaminated forthis requiring extensive cleaning.

c.         Complex Repair: For this require more than layered closure Ex: scar revision, debridement.

9)     How many types of closures are there?

a.      One layer closure is simple repair.  Two layers of more is intermediate repair.  Up to muscle closure complex repair example debridement, scar revision.

10)Lesion Excision

a.      Surgical removal of lesion means any abnormal skin condition.

11)What is close reduction and open reduction?

a.      Fracture reduced without incision is Closed Reduction and the one that is reduced with an incision is Open Reduction

12)Closed facture is treated with open reduction? (Is this True)

a.      Yes- It is treated with open reduction with internal fixation(ORIF)

13)Basic Surgical coding guidelines in surgery section?

a.      Differs body system to system and main guidelines are anesthesia and fluoroscopic guidance observed or done

14)Radiology coding?

a.      70000 series mainly having two components like professional and Technical component.  Any procedure which involves images called as radiology coding. Modifiers are 26, TC, 50, RT, LT, 59.

15)What are basic key components in evaluation and management?

a.      7 Components are History, Examination, MDM-Medical Decision Making , Counselling, Coordination of care, Nature of presenting problem and Time

b.      The 3 basic key components are HX, Exam and MDM.

Urgent Care Coding

Urgent Care Coding:

Urgent Care Centers are the Facilities that deliver Outpatient Medical Care usually for the conditions that do not require Hospital admission. Urgent care centers are primarily used to treat patients with acute and chronic injury or illness (that is not life-threatening conditions for the patient) that requires immediate attention. Urgent care Facilities are designed to treat Unscheduled / walk-in patients that normally serves 24/7 a week. Urgent care Centers are also known as After-Hours Facility that serves Non-emergency conditions that includes

Fractures / Sprain / Strained / Twisted Ankles and other joints
Cuts, Minor injury and Lacerations
Cold, Cough and Sore throat
Burns and Skin Rashes
Ear infection
Incision and Drainage of Abscess
General Wound Care
Insects / Animal bites
Mild Asthma
Allergies
Fever / Flu symptoms
Swine Flu / H1N1
Destruction of Warts etc
Immunizations & vaccinations
Heath Services (includes physical examinations) for Children, Men and Women


Urgent Care Coding and Reimbursement

Urgent care services are coded based on the level of services rendered by the physicians to the patients similar to a physician office visit (CPT 99201 - 99215). Most of the insurances reimbursement would be based on a Flat rate method that combines the services and other procedures performed on the same day. Few carriers reimburse the Urgent care centers based on the level of services and are normally categorized as three levels. BCBS of Florida would be an ideal example for such reimbursements where the CPTs 99201-99202 & 99211-99212 are categorized as Level 1, CPTs 99203 & 99213 would have a reimbursement rate higher than Level I and are categorized as Level II services and 99204-99205 & 99214-99215 would have a greater reimbursements than Level I and Level II and are categorized as Level III services. Please refer reimbursement rates provided by Florida BcBs for Urgent Care Centers athttp://www.bcbsfl.com/DocumentLibrary/Providers/Content/T_ACFSUCC1108.pdf 

Just to give an idea for the Coders on these three Levels of services:

1. Level I / Triage care (Minor Problems): If only Evaluation and Management services are rendered to the patients with no diagnostic tests
2. Level II / Intermediate care (Moderate): If injections and vaccines, splinting are given along with E & M services
3. Level III / Complex care (severe): IF IV infusion, sutures are performed along with E & M services


FAQ's

What is the difference between Emergency departments and Urgent Care Facilities?

Emergency departments are part of Hospitals that provides care to the patients with critical conditions such as heart attacks, Motor Vehicle Accidents, Poisoning and Suicidal attempts and other such Life-threatening conditions whereas Urgent Care Facilities serves the patients with Non-emergency conditions but requires immediate attention i.e., a relatively short period of time (which CMS defines as 12 hours) to avoid adverse consequences. 

Emergency services are defined as being services furnished to an individual who has an emergency medical condition. Under the regulations at 42 CFR §424.101, hospital emergency services are defined as services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services. 

Urgent Care Services are defined in 42 CFR 405.400 as services furnished within 12 hours in order to avoid the likely onset of an emergency medical condition. 

Can we bill CPT 99281 - 99285?


Do not code 99281 - 99285 for the services rendered in the Urgent Care Center since these codes represents the emergency services rendered in the Hospitals and are reimbursed in POS 23 (Emergency room) and not to be used in the POS 20 (Urgent Care Facility).

Should we need to bill CPT S9083 for all patients?

CPT S9083 represents all the service(s) and or procedure(s) performed on a particular day and it is not necessary to report this CPT for the carriers if the reimbursement is based on the Level of services. CPT S9083 would be reported to the insurances where the reimbursement is based on the Flat rates (Global Fees) and if the insurance ask the providers to do so as per the contractual agreement. CPT S9083 bundles all services rendered in an Urgent Care center - whether the visit might be for a hangnail or a heart attack. This methodology of reporting CPT S9083 might be a financial drop for Urgent Care Centers. As a precaution the Urgent Care Centers should request a modification on case-rate coding and to get the list of Carve-out codes in addition to the global reimbursement on CPT S9083. CPT S9083 is not valid for Medicare and Medicaid insurances.

What are Carve-out codes? 

Carve-out codes represents the services or the procedures that has to be separately reimbursed other than the Global Fee contract agreement. The Carve-out codes are similar to Medicare's Carve-out Preventive Services.

When CPT S9088 should be billed?

CPT S9088 could be billed to all unscheduled, walk-in patients to the urgent care centers. This CPT should not be billed alone since it is an add-on code and should be billed with other services rendered on the same day unless restricted by contract or regulations. CPT S9088 is not valid for Medicare and Medicaid insurances.

Can we bill CPT 99058 and 99050? 

Do not bill CPT 99058 and 99050, as they would not be paid separately as Urgent Care Centers itself refers to an After-Hours Facility.

Can we bill CPT 99211 in Urgent Care centers?

Yes we could bill CPT 99211 if the patient comes for a BP check, PPD Test / reading, Refills, B12 injections etc., where the presence of physician may not required.

Can we bill Post Operative services? 

No, postoperative services neither be billed to the insurances nor to the patients unless the patient is encountered for a different reason within the Global period of previously performed surgery.

Does authorization and Referral required for Urgent Care visits?

Not required.

CLIA Program and HIPAA Privacy Rule

 Patients' Access to Test Reports

A Proposed Rule by the Centers for Medicare & Medicaid Services on 09/14/2011

This proposed rule would amend the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to specify that, upon a patient's request, the laboratory may provide access to completed test reports that, using the laboratory's authentication process, can be identified as belonging to that patient. Subject to conforming amendments, the proposed rule would retain the existing provisions that provide for release of test reports to authorized persons and, if applicable, the individuals (or their personal representative) responsible for using the test reports and, in the case of reference laboratories, the laboratory that initially requested the test. In addition, this proposed rule would also amend the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to provide individuals the right to receive their test reports directly from laboratories by removing the exceptions for CLIA-certified laboratories and CLIA-exempt laboratories from the provision that provides individuals with the right of access to their protected health information.

HHS Sets Goal of 50% of Physicians Using EHRs by Year End

2013 Agenda to Focus on Improving Care through Health IT

Yesterday the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner and the National Coordinator for Health Information Technology Farzad Mostashari, M.D., announced HHS’s plan to accelerate health information exchange (HIE) and build a seamless and secure flow of information essential to transforming the health care system.

“Thanks to the Affordable Care Act, we are improving the way care is delivered while lowering costs,” said Acting Administrator Tavenner.  “We are already seeing benefits, such as a reduction in hospital readmissions due to these reforms.  Health IT and the secure exchange of information across providers are crucial to reforming the system, and must be a routine part of care delivery.”

This year, HHS will:

• Set aggressive goals for 2013: HHS is setting the goal of 50 percent of physician offices using electronic health records (EHR) and 80 percent of eligible hospitals receiving meaningful use incentive payments by the end of 2013.
• Increase the emphasis on interoperability: HHS will increase its emphasis on ensuring electronic exchange across providers.  It will start that effort by issuing today a request for information (RFI) seeking public input about a variety of policies that will strengthen the business case for electronic exchange across providers to ensure patients’ health information will follow them seamlessly and securely wherever they access care.
• Enhance the effective use of electronic health records through initiatives like the Blue Button initiative.  Medicare beneficiaries can access their full Medicare records online today. HHS is working with the Veterans Administration and more than 450 different organizations to make health care information available to patients and health plan members.  HHS is also encouraging Medicare Advantage plans to expand the use of Blue Button to provide beneficiaries with one-click secure access to their health information.
• Implement Meaningful Use Stage 2:  HHS is implementing rules that define what data must be able to be exchanged between Health IT systems, including how data will be structured and coded so that providers will have one uniform way to format and securely send data.
• Underscoring program integrity: HHS is taking new steps to ensure the integrity of the program is sound and technology is not being used to game the system.  For example, it is conducting extensive medical reviews and issuing Comparative Billing reports that identify providers.

The goals build on the significant progress HHS and its partners have already made on expanding health information technology use.  EHR adoption has tripled since 2010, increasing to 44 percent in 2012 and computerized physician order entry has more than doubled (increased 168 percent) since 2008.

“The 2014 standards for electronic health records create the technical capacity for providers to be able to share information with each other and with the patient,” said Dr. Mostashari. “Through the RFI, we are interested in hearing about policies that could provide an even greater business case for such information sharing.”

In addition to seeking public input, the RFI also discusses several potential new policies and ideas to accelerate interoperability and exchange of a patient’s health information across care settings so that they can deliver better and more affordable care to their patients.

The RFI can be found at http://www.ofr.gov/OFRUpload/OFRData/2013-05266_PI.pdf. Deadline for comments is April 21, 201

What meaningful use stage 3 could require

Preliminary recommendations for stage 3 of the federal electronic health record program — starting for some doctors in 2016 — would retire some measures, increase thresholds for others and add new requirements to achieve meaningful use. Key changes proposed include:

• Removing the requirement to record smoking status during at least 80% of patient visits. Instead, smoking status would be tracked by a clinical quality measure.
• Implementing 15 clinical decision support intervention requirements, up from five in stage 2 and one in stage 1.
• Requiring clinical summaries that are pertinent to office visits be sent to patients within one business day during 50% of eligible encounters. The threshold is the same, but the summary cannot be just an abstract of the record.
• Directing practices to use EHRs to query research systems for clinical trials. The new certification criteria would identify patient eligibility for relevant trials.
• Requiring the identification of education resources in five non-English languages and mandating that 80% of materials written in at least one of those languages be made available to patients.

Source: “Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records,” HHS Office of the National Coordinator for Health Information Technology, HIT Policy Committee, Nov. 27, 2012  (www.healthit.gov/sites/default/files/hitpc_stage3_rfc_final.pdf)