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.