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HEALTHCAREBUSINESS MONTHLYCoding | Billing | Auditing | Compliance | Practice Management

March 2016

Fight for Insurance Carrier Payment: 27

Have a game plan that gets you paid

The NPP Scope of Practice Scoop: 48

Meet state practitioner authorization requirements

Time Is Ticking on Old Accounts: 55

Manage unpaid claims now to increase revenue

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www.aapc.com March 2016 3

[contents]■ Coding/Billing ■ Practice Management ■ Auditing/Compliance

[continued on next page]

Healthcare Business Monthly | March 2016

24 Better Bronchoscopy in 2016 Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P,

CPC-I, CENTC, CPCO

44 2016 OIG Work Plan: Part A Risk Areas

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA

55 Don’t Let Medical Billing Accounts Grow Old

Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT

COVER | Coding/Billing | 34

Hold Strong When Shoulder Arthroscopy Weighs You DownBy Michael Strong, MSHCA, MBA, CPC, CEMC

4 Healthcare Business Monthly

Healthcare Business Monthly | March 2016 | contents

18

30

48

■ Legal Advisory Board16 Yates Memorandum: Follow Up Implications for Coders Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, and Stacy Harper, JD, MHSA, CPC

■ Coding/Billing18 CPT® 2016: Urinary Interventional Coding

David Zielske, MD, CIRCC, CCVTC, COC, CCC, CCS, RCC

24 Better Bronchoscopy in 2016 Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO

27 Fight for Insurance Carrier Payment

Wendy Grant-Denton, CPC

30 Cerumen Removal Coding Depends on Impaction, Method John Verhovshek, MA, CPC

Quick Tip32 In a Nutshell: Category II Codes John Verhovshek, MA, CPC

38 Make the Most of Hierarchical Condition Categories Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC

40 2016 Brings Opportunity to Increase Revenue Oby Egbunike, CPC, COC, CPC-I, CCS-P

Quick Tip42 Don’t Overlook Obstetric Panel Alternative Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, CCS

■ Auditing/Compliance48 Get the Scoop on NPP Scope of Practice Stacy Harper, JD, MHSA, CPC, and Chandler Carr

52 Be Aware of Your Payers’ Teaching Physician Guidelines Judy Harris-Guay, CPC

DEPARTMENTS

7 Letter from Membership Leader

8 Letters to the Editor

8 Chat Room

9 I Am AAPC

10 AAPC National Association Board

14 AAPC Chapter Association

17 Healthcare Business News

43 Dear John

58 Member Feature

EDUCATION60 Newly Credentialed Members Online Test Yourself – Earn 1 CEU www.aapc.com/resources/publications/

healthcare-business-monthly/archive.aspx

COMING UP: • OIG Work Plan: Part B • Doctor Humor • CMS EHR Toolkit • Dialysis Access • Rock the Mock

On the Cover: If shoulder arthroscopy surgery coding is weighing you down, Michael Strong, MSHCA, MBA, CPC, CEMC, has guidance to help lighten the load. Cover illustration by Kamal Sarkar.

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Volume 3 Number 3 March 1, 2016Healthcare Business Monthly (ISSN: 23327499) is published monthly by AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240, for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT 84120-7240.

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Go into your Profile on www.aapc.com and make the change!

March 2016

Ask the Legal Advisory BoardFrom HIPAA’s Privacy Rule and anti-kickback statute, to compliant coding, to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC’s Legal Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to [email protected] and let the legal professionals hash out the answers. Select Q&As will be published in Healthcare Business Monthly.

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Letter from Member Leadership

I can hardly believe we are wrapping up the first quarter of 2016 already. We have seen

a lot of emotion in these first three months at AAPC. It was with great sadness that we learned of the passing of a former president of the National Advisory Board (NAB), Ter-rance C. Leone, CPC, CPC-I, CPC-C, CIRCC, or Terry. Please take the time to read the article on page 10, in which some of his colleagues and friends share sentiments about him and the effect he had on their lives.

Reflect on a Successful LifeAlthough we are saddened to hear of his passing, we can use this time to evaluate where we are, and look to Terry for inspira-tion.

Here was a man truly dedicated to his family, and yet he found time to be dedicated to his career and AAPC, as well. Terry realized he wanted more for his career and our organiza-tion, and set a path to get there. He achieved so much in his life, including becoming the first male NAB president of an organization that was over 99 percent women, at the time.

Assess Yourself and Your AmbitionsLooking back at his successes as a family man, a professional, and a mentor, I think about where I am now and I begin to assess what I can do better. You, too, may be asking these questions:

• Where am I at completing goals I have previously set?

• Are those goals still attainable?• Have I strayed off course?

If you’re unsure of where you are or the goals you want to set, there are two great ways to get you back on track:

1. Take a look at the AAPC website home page (www.aapc.com). You’ll be amazed at all the information and opportu-nities that are presented to you on the first page alone. When you dig deeper, you’ll find course offerings to suit your individual needs.

2. Read Healthcare Business Monthly. This month, the topics range from hi-erarchical condition categories, to transcription and procedure coding, to ICD-10. Perusing these pages is a great way to expand your horizons.

Be PassionateWhatever you are doing now or decide to do in the future, be passionate about it and put your heart into it. Terry did, and it made a difference.

As always, thank you for your time in reading this message. Please let your NAB representatives know if you have any ques-tions or concerns.

Take care,

Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMCPresident, National Advisory Board

Whatever you are doing now or decide to do in the future, be passionate about it and put your heart into it.

Be Inspired By a Man Who Set High Standards


Please send your letters to the editor to: [email protected] to the Editor

Fee Schedule Corrections“Relative Value Units: The Basis of Medicare Payments” (January 2016, pages 50-51) states that the 2015 Medicare Physician Fee Schedule conversion factor is $33.9764. The correct number is $35.7547. As well, the correct amounts of physician expense relative value units for CPT® 17260 De-struction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curette-ment), trunk, arms or legs; lesion diameter 0.5 cm or less are 1.59 non-facility and 0.91 facility.Kim Pollock, RN, MBA, CPC, CMDP

Be Certain to Observe Scribe GuidelinesAlthough there are many great ideas in “Get the Message to Your Clinicians” (February 2016, pages 42-43), I would caution readers regarding saving time for the providers by having medical assistants document for them. This is considered “scribing,” and there are strict Medicare guidelines regarding this. Before a practice considers using staff to document in the electronic health record, they should familiarize themselves with these requirements. Sue Vermette, CPC

For more information about scribes and the rules that regulate their use, see “The Medical Scribe: A Hot Commodity” (December 2015, pages 50-52).

www.aapc.com


January 2016

Dodge Pediatric Vaccine Obstacles: 28 Be diligent with documentation review

2016 OPPS = Overall Decreases: 52 Policies may affect the entire industry

Value-based Payment Modifier Basics: 56 Quality care at a low cost is key to positive adjustments

January2016_HBM.indd 1 10/12/15 8:26 pm

Chat Room

CHAT

ROO

M

Let’s Hear It for Our National-level MembersIf you post on AAPC’s Facebook page, many AAPC members and em-ployees read your threads. Our staff enjoys reading your posts and feed-back, and especially loves when you spread positive messages to fellow members. We were excited to read a couple of posts from members Rob-in Moore, CPC, Toledo, Ohio, local chapter president, and Dolores Du-Mont, Hollister, California, which gave shouts out to our national-lev-el superstars and a very special staff member, Karen Park.


I worked in production for more than 12 years, but when the company relocat-ed their facilities to another country, I decided to change careers. I enrolled in

an occupational program and started a year-long course in accounting. Half way through the program, my dad had a terrible car accident. The doctors who were involved in his care and rehabilitation would talk to me using words I did not un-derstand, which was very frustrating. A few months later, my mother ended up in the hospital and needed my assistance in her recovery and treatment plan. It was then I decided to switch to the administrative medical assistance program.

Making the Switch to CoderI completed the course and interned at a local doctor’s office. When interviewing for jobs, I brought samples of some of the medical terminology and coding prac-tices I did in class. I landed my first job in the medical field as a data entry opera-tor. We had one coder who worked at night, but she was rarely in the office. Our company acquired a new billing client and needed more coding services, so I be-gan coding full time, coding mainly radiology and physician claims. At the same time, my boss bought the AAPC independent study program, which I studied at night. I passed my Certified Professional Coder (CPC®) in 2000, after only a year on the job.

Changing Gears to Hospital CodingI was interested in learning hospital coding, so I applied for a job with a local hos-pital, did well entrance test, and was hired. My on-the-job training started in out-patient and emergency room abstract coding. I took an advanced hospital billing/Certified Coding Specialist (CCS) prep online, and I received my CCS credential in 2014. I was also able to make the transition from ICD-9 to ICD-10 after a lot of company-sponsored training. I now work remotely, full time in Arizona while caring for my mother.

Spreading Knowledge through MentoringMy career goal is to develop a program or mentor people interested in coding as a profession. I want to help new coders understand how to start, what will be re-quired, and if coding is the right career choice for them. I have been blessed with an awesome career and a great team of people to work with, and I want to share what I’ve learned with whomever is interested in medical coding.

I Am AAPC

#IamAAPCHealthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your stories and a digital photo of yourself to: Michelle Dick ([email protected]) or Brad Ericson ([email protected]).

LORIANN GILLETTE, CPC, CCS

#Ia

mA

AP

C


By Angela Jordan, CPC

■ AAPC NATIONAL ADVISORY BOARD

I learned of Terrance (Terry) Leone’s, CPC, CPC-I, CPC-C, CIRCC, passing on Facebook. On January 4, 2016, Rhonda Buck-holtz, CPC, CPCI, CPMA, CRC, CHPSE, CENTC, CGSC, CPEDC, COBGYN, posted, “This great man is no longer with us. Terry was a great leader, a passionate and compassionate past board president. I was proud to call him friend and mentor. May God bless his family.” I was shocked.

I didn’t get the opportunity to serve on the NAB with Terry, but he was the one who encouraged me to apply for the NAB. During the AAPC National Conference in 2008, the NAB hosted an event for anyone interested in learning more about it. It was during that event that I met Terry. His interest was genuine and his passion for our pro-fession was evident. We talked about radiology, AAPC, and even our home towns. There were other members hovering around eager to speak with him. As I politely excused myself, he told me I would be great for the NAB. I did apply in 2008, and was selected as a member of the AAPC Chapter Association.

A Resounding AffectI knew if Terry had such an affect on me, there were more accolades, memories, and stories to be shared by those who knew him well and served on the NAB with him. If you never had the opportunity to meet him, here is a glimpse into his character and influence as an AAPC member, NAB leader, healthcare business professional, and friend.

Nancy Clark, CPC, COC, CPB, CPMA, CPC-I Elberon, New Jersey

Terry was one of the friendliest people I have ever known. I approached him at a conference with questions about becoming a NAB member. We spoke for over an hour, and I felt as though I had known him for years. He encouraged me to apply for the NAB. He told me how much he enjoyed meeting AAPC members, and how he thought I would, too. He was right. Terry encouraged me to begin one of the most remarkable experiences of my life. For that, I will always remember him. AAPC has lost one of its true stars.

Julie Croly, CPC, CPC-I, CPC-P Honolulu, Hawaii

Terry gave each of us on the NAB who served with him a pewter tree. It stood for the strength of coders, the NAB, and AAPC. The branches stood for how we “branch out” to help our fellow coders,

Remembering Terry LeoneThe National Advisory Board (NAB) shares sentiments and stories about an AAPC national leader and friend.



Memorial

NATIONAL ADVISORY BOARD

and the overall strength and growth of the profession. From the day he gave me mine, I have displayed it proudly on my desk.

I try not to focus on the sadness of his passing, but how he touched so many people by being such a wonderful person, colleague, and friend.

Terry’s pewter trees represent the strength and growth of fellow coders.

Gail Donlin, CPC Burlington, Vermont

I first met Terry when he came to my facility to audit our radiology coding. It was from that meeting, we developed our working rela-tionship; and it was through his efforts, I was elected to the NAB. We both shared a love of radiology coding, especially interventional radiology. He was my mentor and my friend.

David Dunn, MD, FACS, CIRCC, COC, CCVTC, CCC, CCS, RCC Nashville, Tennessee

I thought very highly of Terry, knowing him for the past eight or nine years. He was a family man in the true sense and I respected him for that. I worked with Terry on the NAB and found him very loyal to AAPC. He worked very diligently during his tenure on behalf of the NAB. Terry encouraged me to run for NAB president and because of Terry and his mentoring, I ran and thoroughly enjoyed myself — all because of Terry.

When my son was considering Cornell, Terry was very helpful in our planning for a trip to visit the college, which is relatively close

to where Terry lived. He even said if my son went there, he would be happy to help if an emergency arose, as getting to Ithaca from Nashville does take time. Terry once told me he went to a hospital in Buffalo where a friend’s son was being prepared for an emergency appendectomy and stayed until the parents could travel there. I will truly miss Terry Leone.

Linda Duckworth, CPC, CHC Lone Jack, Missouri

I had the pleasure of serving on the NAB with Terry for two years. I appreciated his sense of “calm during the storm.” If we, as a board, had issues to address that would uncover varying — and sometimes strong — opinions, we could count on Terry to appreciate both sides and value our input. I felt that he was a strong leader and a wonderful representative of coders of all specialties across the country. Most of all, he was a kind man and a cherished friend.

Linda R. Farrington, CPC, CPMA, CPC-I, CRC Colorado Springs, Colorado

It was a pleasure working with Terry on the NAB. He was a class act. I observed many times where Terry put others first. He was a kind man and a thoughtful leader. He will be missed in our coding community. May his wife and family find peace and comfort.

Rita Genovese, CPC, PCS Philadelphia, Pennsylvania

The one thing that stands out in my mind when I think of Terry is his smile and the warmth he projected towards everyone. He was approachable and always willing to answer any question asked of him. He was genuine and a true gentleman.

Melody S. Irvine, CPC, CPMA, CEMC, CFPC, CPB, CPC-I, CCS-P, CMRS Loveland, Colorado

I immediately felt a bond with Terry when I met him because reminded me so much of my brother. I used to tease him of his fast talking, New York accent. I also vividly remember the day he called and asked me to serve on the 2011–2013 NAB in the officer mem-ber relations position. He said, “Mel, we need your sense of humor on the board.” He respected my opinions, and more importantly, we could always make each other laugh. He was compassionate about his family and the coding field. I will miss you Terry and your great smile, and you will always have a special place in my heart for

If you never had the opportunity to meet him, here is a glimpse into his character and

influence as a NAB leader and friend.



Memorial

the opportunities you shared and gave to me.

Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I San Diego, California

As the current NAB president, I have of-ten looked back at some of Terry’s articles from Healthcare Business Monthly (then, Coding Edge) for support and guidance. He offered a lot of wisdom during his tenure on the NAB. We were fortunate to have him as a part of this organization. His voice will certainly be missed.

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI Sacramento, California

I served on the NAB with Terry and came to know him as a friend. We exchanged birthday wishes and found time to catch up at conferences. Terry always made time to talk to everyone. He had a warm and inviting smile. It was important for him to be with the chapter members at conferences. You’d find him walking around the conference and talking to the attendees. He wanted to make sure everyone felt welcomed and appreciated. Terry’s heart was as big as his smile. He had a way of lighting up the room. Terry spoke often of the importance of his family and taking care of them. I had the pleasure of meeting his family at one of the conferences; he was very proud of them. I will always respect Terry’s values and his respect for others, and have fond memories of Terry. My heart goes out to Terry’s family and friends. He will be greatly missed.

Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CPMA Central City, Pennsylvania

While it’s both polite and common to say nice things following anyone’s passing, Terry is truly deserving of any accolade. Terry helped shape AAPC into the professional organization it is today. His passion for coding was infectious, and his dedication to AAPC and its members was noteworthy. I had the honor of serving with

him on the 2007-2009 NAB when he was president-elect. That experience and his example helped kindle my own passion to continue his work in advancing the profes-sion of coding. His dedication to learning, professionalism, and service is something we can all strive to emulate. His passing is a great loss to the family of coders that he leaves behind. He will be sorely missed.

Suzanne Quinton, CPC, COSC, CPC-I Broken Arrow, Oklahoma

I served with Terry on the 2007-2009 NAB and, although I didn’t get to know him well on a personal level, he was a tremendous asset to the board. He was well respected in his field, and his opinions and ideas were well perceived by everyone. He was somewhat quiet, compared to the excitement level of Susan Ward, Cyndi Stewart, Yvonne Dailey, Jonny Massey, and myself, but he was a game player when it came to performing skits. We

were a particularly close group of board members; the loss of Terry has been felt far and wide.

Terri Scales, CPC, CCS-P Indianapolis, Indiana

From 2009 to 2011, I got to know the wonderful man that was Terry Leone. Terry and I served on the AAPC NAB together. The coding world had a great leader who took us over the 100,000 mem-ber threshold. I remember the AAPC National Conference where Terry was introduced as our new NAB president. He was so excited to encourage our members to stay strong through a changing time in healthcare. Coders were being challenged by the introduction of the electronic health record. He reassured us that our chosen careers were more important than ever and that AAPC credentials were the strongest and most respected in healthcare. He was right! Terry will always be remembered as a strong leader to AAPC and its members.

Toni L. Slocum, CPC, CPC-P, AHFI Portland, Oregon

I was honored to call Terry my friend and that was due to him. Once

April 2009

NAB president, Terry Leone, CPC, CPC-I, CPC-P, CIRCC

Plus: 2009-2010 NAB • Sepsis • PT / OT • Mohs Micrographic Surgery • Screening Colonoscopy

NABLeadership: Born from Coding

NATI

ONAL

ADV

ISOR

Y BO

ARD

You can read Terry’s articles in past issues of Coding Edge Magazine.


Terry’s pewter trees represent the strength and growth of fellow coders.


Memorial

you met him, that was it; he always made you feel like you were a friend. Terry and I spent a good amount of time talking about our mutual love of the New York Yankees and my favorite: listening to him tell me stories about his family. Although I never met them, he spoke so highly and lovingly about them; it was as if I knew them, too. Terry was truly a gentleman’s gentleman, and the world will be a little less wonderful without him.

Arlene Smith, CPC, CEMC, COBGC Tacoma, Washington

I served on the NAB from 2007-2009 with Terry. I remember him as warm, friendly, and always ready to listen. We worked together behind the scenes at conferences, and he made those long days fun. Such a wealth of coding knowledge, I enjoyed attending his presentations at conferences after our time together on the NAB ended. He always greeted me with a smile and remembered me from my time on the NAB with him. He will be greatly missed.

Angelica Stephens, RHIT, CPMA, COC, COSC, CPC, CCS-P Albuquerque, New Mexico

I did not have the opportunity to meet Terry, but I can assure you that he will never be forgotten. As a radiology coder, I refer quite often to his article “Seven Tips for Diagnostic Radiology Coding Success.”* He touched our lives in many different ways.

* If you’d like to read the article “Seven Tips for Diagnostic Radiology Coding Success,” see the September 2010 issue of AAPC’s Coding Edge: www.aapc.com/blog/26233-seven-tips-for-diagnostic-radiology-coding-success/.

Cynthia Stewart, CPC, COC, CPMA, CPC-I, CPMA Olsburg, Kansas

I had the pleasure of knowing Terry both professionally and person-ally. I met Terry while serving on the NAB and was his president-elect while he served his term as president of the NAB. Terry was very pas-sionate and outspoken about AAPC, its members, and their needs. He could often be found at conference in a quiet corner speaking with

members, many of whom he had just met. It was his goal to meet as many members as possible in the short time allowed dur-ing conference. Terry was always willing to help or offer advice when assistance was needed. He was a caring and compassion-ate colleague with a unique sense of hu-mor and a boisterous laugh. His absence will be felt for many years to come.

Beverly Welshans, CHC, CPMA, CPC, CPCI, COC, CCSP Buffalo, New York

For me, Terry was synonymous with AAPC. I first encountered Terry in 2001 when he was traveling from Rochester to Buffalo to get the Buffalo chapter off the ground. He devoted countless hours to es-tablishing the chapter, and always provid-ed emotional and financial support. Terry encouraged me to run for the NAB, and serving under him was a pleasure. Over

the years, I frequently reached out to him for expert advice on radiol-ogy compliance. I had several opportunities to see him with his fam-ily at AAPC conferences, and he appeared to embrace them with the same dedication and enthusiasm that he did AAPC. He will be sore-ly missed.

Carrying on Your LegacyAs I read through the memories shared by past and current NAB members, I wonder if Terry knew the impression he left on AAPC and the members he encountered along the way. My guess is he saw him-self as “one of us” and not fully realizing the catalyst he had become. Thank you, Terry, for being a steadfast leader, a mentor, a consum-mate educator and, above all, a friend. Your contributions will not be forgotten.

Angela Jordan, CPC, is managing consultant at Medical Revenue Solutions, LLC, with more than 25 years of experience in the healthcare field, and has been a member of AAPC for 15 years. Her career path has taken her from a small family practice, radiology, large physician services group to a managing consultant. Jordan is a member of the AAPC NAB and has held many offices in the Kansas City, Mo., local chapter, including president. In 2009, she served as a member of the AAPC Chapter Association board of directors and was the chair in 2012.

Terry participating at an AAPC National Conference skit.

NATIONAL ADVISORY BOARD

We’ll Miss You, Terry.


http://www.aapc.com/blog/26233-seven-tips-for-diagnostic-radiology-coding-success/

http://www.aapc.com/blog/26233-seven-tips-for-diagnostic-radiology-coding-success/


By Holly Brown, CPC, COC, CEMC, CPCO

AAPC Chapter Association

Get Excited for May MAYnia 2016!It’ll be here before you know it, so start preparing to make it your best yet.

The month of May is quickly approaching, and we all know what that means: flowers blooming, birds chirping, and May MAYnia. It’s almost time to show off your local chapter and dazzle your members.

Take the opportunity to network, have some fun, and showcase all AAPC has to offer its members, including:

• Two new credentials: Certified Inpatient Coder (CIC™) and Certified Risk Adjustment Coder (CRC™)

• Bigger and better national and regional conferences

• ICD-10 training and low cost continuing education units

Let the Ideas FlowHere are some ideas for getting local chapter members excited about May MAYnia:

• Make a day of it and offer a seminar. Some chapters change the date of their regular chapter meeting and have May MAYnia on a Saturday or Sunday. In giving members the whole day for education, you can offer more CEUs than a regular meeting and extra time to network with other healthcare business professionals.

• Have some fun and host a night of games. Make a jeopardy board and ask coding/billing questions or play Pictionary and race to draw pictures of the human anatomy. Whatever you do, create excitement for members with fun, competitive energy.

• Get well-educated speakers. Bring in knowledgeable experts to enlighten

members with important education in healthcare. For example, a physician might speak about a new

procedure or a coder might speak about a particular topic in which he or she is an expert.

• Promote healthcare in your community. Invite a nonprofit organization to speak about a healthcare issue they advocate. In 2012, the Orange Park, Florida, local chapter invited a speaker from “Take it to Heart,” who discussed heart disease in women and the steps women can take to reduce the risks. It was very informative, and they made it fun by holding a raffle and handing out T-shirts.

Get CreativeMake sure to give your members as much notice as possible and really hype up the event. Encourage them to bring friends and colleagues. The more, the better. AAPC will provide fantastic prizes for the meeting, as well.

May MAYnia is the event of the year. Whatever you decide to do, make it big and make it fun for your members.

Holly Brown, CPC, COC, CEMC, CPCO, is a coding quality analyst for Optum 360. She started out at the front desk of a multi-physician cardiology practice in 2006 and soon after transferred to the billing office. Brown now specializes in quality/training and audit-

ing E/M and outpatient services for physicians and hospitals. She helped start the St. Augustine, Fla., local chapter in 2009, and has served as pres-ident-elect and president. In 2012, Brown helped start the Orange Park, Fla., local chapter, where she has also served as president.

Whatever you do, create excitement for members with fun, competitive energy.



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Yates Memorandum: Follow-up Implications for CodersExplore further into the DOJ’s individual accountability for corporate wrongdoing.

“Corporate Wrongdoing Falls on the Individual,” (February, pages 44-47) provided an excellent analysis of the Department of Justice’s (DOJ) recent memorandum, which contained guidance to U.S. at-torneys for identifying individuals responsible for corporate miscon-duct. The approach is to essentially leverage what is called “coopera-tion credit” for disclosures that will help the DOJ identify who is re-sponsible for corporate misconduct. Unfortunately, some are reading more into this article than was intended.

Your Responsibility, Plain and SimpleWhen investigating corporate entities for civil or criminal miscon-duct, the DOJ is looking to identify and prosecute the individuals in the corporation who are responsible for the misconduct. The key, however, is that the DOJ is looking for the responsible corporate de-cision-makers or the individuals actively participating in the miscon-duct. The low-level employees who are passive in the misconduct and required to do what they are told are not likely targets. As such, if you are a front-line coder, or even a coding department supervisor, you’re not likely the person the DOJ is going to focus on unless you are ac-tively involved in the misconduct and/or financially benefitting from the misconduct. A recent case out of Illinois illustrates active involve-ment: The coder for an in-home visiting physician group was convict-ed of making false statements related to healthcare matters based on creating information necessary to submit a claim for services that she knew never happened. Regardless of personal liability, when you do have concerns about what you’ve been told to do, you’re responsibility is limited to rais-ing those concerns, and the basis for them, to management or to your compliance department. Do so in writing and retain a copy. Keep copies of any responses or given directives. Not only will these docu-ments establish that you’re not the decision-maker the DOJ is looking to prosecute, but the documentation is exactly the kind of evidence the corporation must disclose to qualify for “cooperation credit.” As a coder or biller, if you are directed to generate claims for services you know were not provided, you must refuse to cooperate in the creation or submission of those claims.

Advice for Decision-makersIf you’re a decision-maker and have made a decision to code or bill in a particular way, even after concerns are raised, and those decisions ul-timately are alleged to be inaccurate, be sure to maintain documen-tation for the basis of your decision. Both civil and criminal liability requires not only wrongdoing, but evidence of intent to defraud. In response to a concern raised by a coder or other employee you super-vise, be certain to obtain an independent, written opinion from your compliance department or external compliance contact. The basis for your decisions and the standards you relied on should be maintained in your organization’s (or your own) compliance binder, and are key to demonstrating your lack of intent.

Bottom LineIn the end, if you’re in a position where you are told to do something you’re not entirely comfortable with, and you’re not actively involved in the misconduct and not the decision-maker, you are not the per-son “responsible” for the misconduct. As a result, you are not the per-son the DOJ will likely focus on. For simple code selection disputes, you have an obligation to at least raise your concerns with your com-pliance department, or if you have no compliance department, then with your supervisor or management. If you’re asked to prepare and submit claims for services that you know were not provided, you must affirmatively refuse to do so.

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of AAPC’s National Advisory Board, serves on AAPC’s Legal Advisory Board, and is AAPC Ethics Committee chair. Miscoe has over 20 years of experience in healthcare coding and over 18 years as a foren-sic coding and compliance expert. He has provided expert analysis and testimony on coding and compliance issues in civil and criminal cases and represents healthcare providers in post-pay-ment audits and HIPAA OCR matters. He is a member and past president of the Johnstown, Pa., local chapter.

Stacy Harper, JD, MHSA, CPC, is a healthcare regulatory attorney with the law firm of Lath-rop & Gage, LLP. She serves on AAPC’s Legal Advisory Board and formerly served on the Nation-al Advisory Board. Harper regularly counsels healthcare providers related to complex billing and coding standards, Medicare participation and payment requirements, Stark, Anti-kickback, HIPAA, and other state and federal healthcare laws. She is a member of the Kansas City, Mo., lo-cal chapter.

By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, and Stacy Harper, JD, MHSA, CPC

■ Legal Advisory Board


AAPC - Webinars

Healthcare Business News ■

DMEPOS Coding and Billing Updates in 2016Along with the durable medical equipment, prosthetics/orthotics and supplies (DMEPOS) fee schedule adjustments are several cod-ing changes.

Coding DMEPOSThe following new HCPCS Level II codes are effective January 1, 2016:A4337 Incontinence supply, rectal insert, any type, each

E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/plat-form, complete system, any type

E0465 Home ventilator, any type, used with invasive interface (e.g., tracheostomy tube)

E0466 Home ventilator, any type, used with non-invasive interface (e.g., mask, chest shell)

L8607 Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies

HCPCS Level II codes deleted from the DMEPOS fee schedule, effec-tive January 1, 2016, are: E0450, E0460, E0461, E0463, and E0464.Code E0465 replaces E0450 and E0463 and code E0466 replaces E0460, E0461, and E0464.

Billing DMEPOSFor gap-filling pricing purposes, the 2015 deflation factors by pay-ment category are:Oxygen - 0.459Capped Rental - 0.462Prosthetics and Orthotics - 0.463Surgical Dressings - 0.588

Parental and Enteral Nutrition - 0.639Splints and Casts - 0.978Intraocular Lenses - 0.962

The 2016 fee schedule update factor is -0.4 percent. For example, the maintenance and servicing fee is adjusted by the -0.4 percent to yield a maintenance and servicing fee of $69.48 for oxygen concentrators and transfilling equipment in 2016.See MLN Matters® article MM8999 Revised for the 2016 update to labor payment rates, effective for claims submitted using HCPCS Level II codes K0739, L4205, and L7520, with dates of service from January 1, 2016, through December 31, 2016.

Source:www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3416CP.pdf

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By David Zielske, MD, CIRCC, CCVTC, COC, CCC, CCS, RCC

■ CODING/BILLING

■ Coding/Billing ■ Auditing/Compliance ■ Practice Management

CPT® 2016: Urinary Interventional CodingPart 1: Understand what changes affect percutaneous urinary interventional coding.

For 2016, the biggest CPT® coding changes affecting intervention-al radiology occur within the subspecialties of urinary, biliary, and neurologic intervention. This month, let’s focus on percutaneous uri-nary interventional coding, and in upcoming articles we’ll cover bil-iary and neurologic intervention codes.

New Codes for 2016There are 12 new urinary intervention codes for 2016. The new codes describe:

Diagnostic nephrostogram 50430 Injection procedure for antegrade

nephrostogram and/or ureterogram, complete diagnostic procedure includ-ing imaging guidance (eg, ultrasound and fluoroscopy) and all associated ra-diological supervision and interpreta-tion; new access

50431 existing access

Percutaneous nephrostomy and nephroureteral catheters 50432 Placement of nephrostomy cathe-

ter, percutaneous, including diagnos-tic nephrostogram and/or uretero-gram when performed, imaging guid-ance (eg, ultrasound and/or fluorosco-py) and all associated radiological su-pervision and interpretation

50433 Placement of nephroureteral cathe-ter, percutaneous, including diagnos-tic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or f luoroscopy) and all associated radiological super-vision and interpretation, new access

50434 Convert nephrostomy catheter to nephroureteral catheter, percutane-ous, including diagnostic nephrosto-gram and/or ureterogram when per-formed, imaging guidance (eg, ultra-sound and/or fluoroscopy) and all as-sociated radiological supervision and interpretation, via pre-existing neph-rostomy tract

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50435 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

Ureteral stents 50693 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ure-

terogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all as-sociated radiological supervision and interpretation; pre-existing nephrostomy tract

50694 new access, without separate nephrostomy catheter

50695 new access, with separate nephrostomy catheter

Three add-on procedures: biopsy, embolization, and ureteroplasty +50606 Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guid-

ance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and in-terpretation (List separately in addition to code for primary procedure)

+50705 Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluo-roscopy) and all associated radiological supervision and interpretation (List separately in ad-dition to code for primary procedure)

+50706 Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluo-roscopy) and all associated radiological supervision and interpretation (List separately in ad-dition to code for primary procedure)

The new codes were well thought out to cover the majority of per-formed urinary cases, and all include both the surgical and super-vision and interpretation (S&I) components of the procedure. All procedures listed above also bundle the use of imaging guidance, including fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). New CPT® guidelines instruct us to code separately for each treat-ed renal collecting system. A renal collecting system consists of the renal calyces, renal pelvis, ureteropelvic junction, and the ure-ter all the way to the bladder. A duplicated collecting system is a normal variant that occurs in approximately 1 percent of the pop-ulation. This may result in two procedures of the same type for a single kidney (each treated, duplicate system is coded separately).

NephrostogramNephrostogram (50430 and 50431) is performed to evaluate the renal collecting system for patency, stones, strictures, malignan-cy, and leaks. These abnormalities can occur anywhere in the col-lecting system, but most often are between the ureteropelvic junc-tion and the bladder. The nephrostogram may be performed via a new access (placing a needle or catheter through the back into the pelvocalyceal system) or a pre-existing catheter (usually an existing nephrostomy catheter). Contrast is injected and imag-ing is performed and interpreted. The procedure is reported with 50430 when performed via a new access, or with 50431 when per-formed via an existing access. Because imaging guidance is per-formed, be sure the ultrasound, CT, or MRI tech does not charge a guidance code when the access uses one of these imaging guid-ance modalities. Nephrostogram is bundled with the new nephrostomy cathe-ter, nephroureteral catheter, and ureteral stent placement codes. The nephrostogram codes may be used as a base code for codes +50606, +50705, and +50706, but only if a catheter is not placed, replaced, or converted. Example: A patient has an existing nephrostomy catheter. Di-agnostic nephrostogram is performed (50431), demonstrating a mid-ureteral stenosis. Ureteroplasty is performed (+50706). No tubes are left in place at the end of the procedure.The following codes do not involve placement of a ureteral stent:

• 50432 describes the initial placement of a percutaneous nephrostomy (PCN) catheter via a new access and includes 50430.

• 50433 describes the initial placement of a percutaneous nephroureteral (PNU) catheter via a new access and includes 50430.

• 50434 describes the conversion of an existing nephrostomy catheter to nephroureteral catheter (removal of the PCN catheter and placement of the PNU catheter over a wire) and includes 50431.

• 50435 describes the exchange of a PCU catheter for a new nephrostomy catheter or the exchange of a

Nephrostogram is bundled with the new nephrostomy catheter, nephroureteral catheter,

and ureteral stent placement codes.



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nephroureteral catheter for a nephrostomy catheter and includes 50431.Example: The patient recently underwent neph-rostomy catheter placement for ureteral obstruction and infection. Now that the infection has subsided, a diagnostic nephrostogram (50431) is performed, showing mid-ureteral stenosis. The nephrostomy catheter is removed over a wire and a nephroureter-al catheter is advanced with the tip in the bladder and secured in position (Add 50434 for the conver-sion of a nephrostomy to a nephroureteral cathe-ter. Delete 50431 as bundled with this conversion.).

Initial Ureteral Stent PlacementsThere are three new codes for initial ureteral stent placements: one via an existing access and two from a new access:• 50693 describes the placement of a double

pigtail ureteral stent via an existing access (prior nephrostomy catheter or nephroureteral catheter access) and includes placing an externally draining nephrostomy catheter (if done).

• 50694 describes the placement of a double pigtail ureteral stent via a new access without leaving a nephrostomy catheter at the end of the procedure.

• 50695 describes the placement of a double pigtail ureteral stent via a new access with separate placement of an externally draining nephrostomy catheter.

All three codes include an initial nephrostogram (50430, 50431) and all imaging guidance (fluoroscopy, ultrasound, CT, MRI) used during the procedure. Example: A patient with an existing nephrostomy catheter pres-ents for conversion to an internalized double pigtail ureteral stent (50693). At the end of the procedure, a new nephrostomy is placed over the guidewire due to excessive bleeding during the procedure (this is bundled with ureteral stent placement).

Nephroureteral stent 50433 for initial placement

Nephrostomy catheter 50432 for initial placement



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The new codes were well thought out to cover the majority of performed urinary cases, and all include both the surgical and

supervision and interpretation (S&I) components of the procedure.

New Add-on CodesCodes +50606, +50705, and +50706 require a base code, which can be any of the catheter placement, conversion, or exchange codes described above, as well as diagnostic nephrostogram codes 50430 and 50431.

• +50606 describes an endoluminal biopsy (brush, needle, or alligator forceps) of the urinary collecting system (renal calyx, renal pelvis, or ureter). If a duplicated collecting system (e.g., bilateral ureters, duplicated ureters) is also biopsied, report +50606 a second time for the separate procedure.

• +50705 describes ureteral embolization and is usually performed to treat a fistula or urinary leak due to an invasive malignancy. Once embolized, a permanent nephrostomy catheter will be necessary for urinary drainage. Ureteral embolization is coded once per ureter.

• +50706 describes ureteroplasty (balloon dilation) of the ureteropelvic junction (UPJ) or the ureter for treatment of a stenosis or occlusion.

The three add-on procedure codes can be submitted once per day, per collecting system and can be performed via any percutaneous access (including a renal access, an ileal conduit, a cystostomy, a ureterostomy, and via a trans-urethral approach). Example: The patient has a nephroureteral catheter in place via an ileal conduit. The patient has a known filling defect in the re-

gion of the UPJ, and is here for biopsy. The catheter is removed over a guidewire and a sheath is placed up to the abnormality. A brush biopsy is performed and sent for pathology (+50606). A new nephroureteral stent is placed over the wire via the ileal conduit (50688 Change of ure-terostomy tube or externally acces-sible ureteral stent via ileal con-duit, 75984 Injection procedure

for ureterography or ureteropyelography through ureterostomy or in-dwelling ureteral catheter). NOTE: This procedure is via an ileal conduit, not via the flank, which changes coding for urinary intervention.

What Stays the Same in 2016Existing codes describe procedures:

• Via an ileal conduit approach (e.g., catheter exchange codes 50688/75984 and nephrostogram codes 50684/74425);

• Via a transurethral approach (e.g., transurethral ureteral stent exchange code 50385 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation and transurethral ureteral stent removal code 50386 Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation); and

• Of non-externally accessible ureteral stents (e.g., percutaneous ureteral stent exchange code 50382 Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation and percutaneous ureteral stent removal code 50384 Removal (via snare/

Deleted and Revised Urinary CodesAlso in this section of CPT®, six codes were deleted (50392, 50393, 50394, 50398, 74475, and 74480) and two were revised: 50390 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous and 74425 Urography, antegrade (pyelos-togram, nephrostogram, loopogram), radiological supervision and interpretation. Code 50390 is now used for placing a needle into a renal cyst to inject contrast or remove fluid. Code 74425 is still used to describe a nephrostogram, but only from a retrograde approach, as done via an ileal conduit, with injection code 50684 Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter.



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capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation).

Other procedures with existing codes include nephroureteral catheter exchange (50387 Re-moval and replacement of externally accessible transnephric ureteral stent (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation), nephroureteral or nephrostomy catheter removal (50389 Removal of nephrostomy tube, re-quiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent)), and creation of an access site (50395 Introduction of guide into renal pelvis and/or ureter with dilation to estab-lish nephrostomy tract, percutaneous) with dilation of a tract between the skin and kidney for stone extraction. With the new codes added in 2016, a comprehensive set of urinary codes is now available to describe almost every procedure performed in the urinary system. The opportunity for cod-ing specificity has never been better.

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC, (Dr. Z) is the founder and CEO of ZHealth, LLC, and ZHealth Publishing, LLC. He practiced as an interventional radiologist for 15 years and has 16 years of experience as a coding reviewer and educator. Dr. Z is Board Certified in Radiology with the Certification of Added Qualification (CAQ) in Interventional Radiology (ABR) (1995, 2005). He was on the AAPC National Advisory Board from 2005-2009, and is a member of the Nashville, Tenn., local chapter.

50395 50688

With the new codes added in 2016, a comprehensive set of urinary codes is now available to describe almost every procedure performed in the urinary system.

illustration 2015 © Optum 360illustration 2015 © Optum 360


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By Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO

■ CODING/BILLING


Better Bronchoscopy in 2016

CPT® 2016 introduced three new codes to describe endobronchial ultrasound (EBUS). Here’s what you need to know to report these services correctly.

Reporting EBUSEBUS combines a bronchoscope with ultra-sound to visualize the bronchi and adjacent structures, and to obtain tissue for biopsy.

In past years, CPT® designated add-on code 61620 to describe EBUS during diagnostic or therapeutic bronchoscopy. For 2016, 61620 was deleted and replaced by two, new standalone codes to describe EBUS for the purpose of obtaining transtracheal and transbronchial sampling:

31652 Bronchoscopy, rigid or flexible, including fluoroscopic guid-ance, when performed; with endobronchial ultrasound

(EBUS) guided transtracheal and/or transbronchial sam-pling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

31653 Bronchoscopy, rigid or flexible, including fluoroscopic guid-ance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sam-pling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures

You may report a single unit of either 31652 or 31653 (but not both), per session,

Consider the changes and apply the rules for three new EBUS codes.

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CODING/BILLINGTo discuss this article or topic, go to www.aapc.com

You may report a single unit of either 31652 or 31653 (but not both), per session, depending on the number of lymph

node stations or structures from which tissue is obtained.

depending on the number of lymph node stations or structures from which tissue is obtained. As an example of proper 31652 use, CPT® Changes 2016: An Insider’s View offers, “In a patient with known or suspected lung cancer, endobronchial ultrasound is used to identify and aspirate/biopsy on mediastinal and one hilar lymph node station.”

Note that sampling by EBUS differs from transbronchial lung biopsy(s) (+31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for pri-mary procedure)) and transbronchial needle aspiration biopsy(s) (+31633 Bronchoscopy, rigid or flexible, including fluoroscopic guid-ance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)), neither of which include an ultrasound component.

Note: For 2016, CPT® includes moderate sedation, when provided, with 31632.

Call on 31654 for Peripheral LesionsCPT® 2016 also created an add-on code to describe EBUS for a diagnostic or therapeu-tic intervention of peripheral lesions.

+31654 Bronchoscopy, rigid or flexible, including fluoroscopic guid-ance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or ther-apeutic intervention(s) for peripheral lesion(s) (List sepa-rately in addition to code for primary procedure[s])

When appropriate, you may report a single

unit of +31654, per session, in addition to primary procedures 31622-31626, 31628-31629, 31640, 31643, or 31645-31646.

CPT® Changes 2016: An Insider’s View provides as an example scenario, “A patient presents with a 1.5-cm peripheral lung lesion. The lesion is identified with transen-doscopic ultrasound probe guidance.”

For instance, when reporting 31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites, if one or more biopsies are taken using EBUS, you would report +31654, as well.

Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, is vice president of Stark Coding and Consulting, LLC., in Shrewsbury, N.J. She is an ap-proved ICD-10 instructor, and a past member of the AAPC National Advisory Board and executive board.

Cobuzzi owned a medical billing company for 13 years before becoming a full time consultant. She is a speaker for many local and national organiza-tions and a member of the Monmouth, N.J., local chapter.

Paranasal sinusesNasopharynx

OropharynxEpiglottisLarynx

Tracheal cartilagesRight bronchusVisceral pleura(covers lungs)Parietal pleura

(lines chest)Rib cage

Diaphragm Right lung (three lobes)

Left lung(two lobes)

Leftbronchus

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By Wendy Grant-Denton, CPC

CODING/BILLING ■


Fight for Insurance Carrier Payment

Fighting with an insurance company to get claims paid can be difficult. Accounts receivable staff must be on top of their game

because incoming payments are needed to pay the light bill, the doctor’s malpractice premium, our salaries, and other necessary practice expenses.

Build a Winning Team To champion your cause, you must have the right people in the right place to handle the claim. This team must understand the denial and know the best way to resubmit the claim. Beyond their skills and knowledge, they also must have:

• Resourcefulness - To get help from others when needed • Persistence - To be a problem solver• Tenacity - To finish with a resolution • Ownership attitude - To care as if these payments belonged

to them MVPs (most valuable players) will:

• Ask the claims examiner the right questions; • Review the entire billing record, not just the one denied

charge; and• Know and understand payer rules.

Face Your OpponentTo begin a successful fight, you must first understand the denial. The five most common denials involve: bundling, non-coverage, insufficient information, failure to prove medical necessity, and eligibility of the patient.

BundlingWhen you report a code combination that may not be billed to-gether, that’s bundling. To avoid this type of error, check Na-tional Correct Coding Initiative (NCCI) edits before submit-ting claims. In the event you receive a denial based on unbundling, check the NCCI tables:

• If they show your combination of codes can never be billed together, the denial was correct.

• If they show your combination of codes may be billed with an appropriate modifier, determine if a modifier would be appropriate and, if so, which one. Resubmit the claim as a “corrected claim.”

• If they show your combination of codes does not have a bundling issue, send an appeal asking for reconsideration, with a copy of the documentation.

Before denials and resubmissions take a toll on your practice, have a game plan that gets you paid.

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Non-covered Denials“Non-covered” can mean a lot of things: The service may not be a covered benefit for the particular patient; the service may be cov-ered, but not the CPT® code billed; or the diagnosis code may not support either the service or the coding.If the payer doesn’t cover the diagnosis code, review the patient’s chart. If another diagnosis was documented, you can bill a cor-rected claim. Example: Depo-Provera® 150 mg (J1055 Injection, medroxypro-gesterone acetate for contraceptive use, 150 mg) is administered with an original diagnosis of Z30.13 Encounter for initial prescription of injectable contraceptives. After re-examining the chart, it is found that the patient received the Depo-Provera® for N80.0 Endome-triosis of uterus. Submit a corrected claim, with the appropriate di-agnosis code tied to the procedure code.Remember: Never make any changes to the documentation after the original claim is filed.If the payer doesn’t cover the CPT® code, review the patient’s doc-umentation. If the wrong code was selected, you can bill a cor-rected claim. Example: A patient has a wellness visit, which was documented, along with instructions to change her blood pressure medication. Code 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. … Typical-ly, 10 minutes are spent face-to-face with the patient and/or family was erroneously selected and billed with ICD-10-CM Z00.01 En-counter for general adult medical examination with abnormal find-ings. Change the CPT® to the age-appropriate wellness visit code, and submit a corrected claim. If the service is truly a non-covered service under the patient’s pol-icy, the service should be billed to the patient. It may be helpful to have a signed Advanced Beneficiary Notice of Non-coverage (ABN) form on file for the patient. Unfortunately, not all carriers use or recognize an ABN.

Claim Needs More InformationMost injury-related claims are denied until the payer can deter-mine the cause of injury. Payers send out communication to the provider, as well as to the patient, asking for details about the in-jury. Was the injury related to the patient’s employment or to a motor vehicle accident? Is there another agency that should be re-sponsible for this claim?The details of the accident can be provided through accurate di-agnosis coding. By selecting a diagnosis from Chapter 20, Exter-nal Causes of Morbidity (V00 – Y99) on the original claim, in ad-dition to a diagnosis from the Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00 – T88), most denials of this nature can be avoided.Other types of claims that “need more info” may be for college-aged dependents. The payer will want proof that the dependent has remained a full-time student. In this case, the patient’s par-ents need to obtain this information, such as a statement from the college’s registrar.Using unlisted codes also requires more information. These codes are used when there is not an adequate CPT® code to describe the services rendered. Usually, the operative note documentation will suffice, as long as the payer can identify what part of the surgical note applies to the unlisted code.

Claim Lacks Medical NecessityIf the service is purely cosmetic, the patient is responsible for pay-ment. The claim should not be adjusted based on the payer’s deni-al due to lack of medical necessity.If the service was medically necessary, the problem could be the frequency in which the service was billed. For example, patients who have diabetes mellitus will customarily have an HgA1C checked every 90 days. Billing the test in shorter intervals than 90 days will cause a medical necessity denial. If the physician has a medical reason to check the levels more often than 90 days, an ap-peal may be submitted, with the chart documentation.

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Patient EligibilityClaims denied due to patient eligibility are the pa-tient’s responsibility, and are out of bounds until suf-ficient and correct insurance information is obtained.

The Winning Way to Overturn DenialsKnowing the best way to overturn a denial is instru-mental in expediting payment. A claim should not be resubmitted simply to try and force a different out-come. Billing claims multiple times never gets results. A corrected claim is always appropriate when diagno-sis codes or CPT® codes need to be changed or mod-ifiers need to be added. Be sure to identify the claim as “correct-ed;” failing to do so may result in another denial because the pay-er may see this second claim attempt as a duplicate. Beat the buzzer: Allowing several months to pass before you cor-rect the claim issue could result in a timely-filing denial.

Step Up Your Appeals Process GameAn appeal is appropriate if you’re dissatisfied with the initial de-termination on a claim. Filing an appeal should include all perti-nent medical documentation. The different levels of appeals vary from payer to payer. Medicare’s level of appeals includes:

• Redetermination must be done within 120 days from the date of the initial determination.

• Reconsideration by a qualified independent contractor is a review, which must be done within 180 days from the date of the Medicare redetermination notice.

• A hearing by the administrative law judge (ALJ) has to be performed within 60 days from the receipt of the reconsideration notice, and there has to be at least $150 in controversy.

• Review by the Medicare Appeals Council (MAC) of the Departmental Appeals Board should be conducted within 60 days from the date of the ALJ decision receipt.

• Judicial review in U.S. District Court has to be requested within 60 days from the MAC decision and at least $1,460 remains in controversy.

Check with other carriers for their appeal levels. Also, get your providers engaged in the appeal process. They need to know when a portion of their claims are being denied. The provider may be able to equip you with an appeal letter explaining in detail what was performed, and why.If all else fails, pick up the phone and call the payer. Hearing the problem over the phone may turn up new information. For exam-ple, a claim for 99232 Subsequent hospital care, per day, for the eval-uation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity … Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit was denied as “bundled in with a previously paid service;” but there is no other service on this patient’s account to which bundling of the 99232 could oc-cur. After contacting the payer, it is found to be a provider/group linkage issue. Sometimes telephone conversations are needed to work through these details.

Wendy Grant-Denton, CPC, has been in the medical industry since 1977. She works as a revenue cycle manager and coding analyst for Community Health Systems. Grant-Den-ton is a member of the Little Rock, Ark., local chapter. She also served on the AAPC Chap-ter Association board of directors from 2009-2013.

Remember: Never make any changes to the documentation after the original claim is filed.

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By John Verhovshek, MA, CPC

■ CODING/BILLING


Cerumen Removal Coding Depends on Impaction, MethodFactor in the components of the common family practice procedure.

Cerumen (ear wax) can build up in the ear canal, which may lead to symptoms of dis-

comfort, dizziness, and impaired hearing for which patients seek medical care. In fact, the American Family Physician website tells us that cerumen removal is the most common ear, nose, and throat (ENT) procedure per-formed in primary care.Coding for cerumen removal depends on two factors:

1. Whether the cerumen is impacted; and

2. If the cerumen is impacted, the meth-od used to remove it.

Not Impacted = E/M ServiceCPT® guidelines tell us, “For cerumen re-moval that is not impacted, see E/M service code …” such as new or established office patient (99201-99215), subsequent hospital care (99231-99233), etc. In other words: If the earwax isn’t impacted, removal is includ-ed in the documented evaluation and man-agement (E/M) service reported and may not be separately billed. Per the American Academy of Otolaryngolo-gy-Head and Neck Surgery (AAO-HNS), ce-rumen is impacted if one or more of the fol-

lowing conditions are present:• Cerumen impairs the examination of

clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition;

• Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.;

• Cerumen is associated with foul odor, infection, or dermatitis; or

• Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills.

The AMA’s CPT® Changes 2016: An Insider’s View confirms, “Impacted cerumen is typ-ically extremely hard and dry and accom-panied by pain and itching. Impacted ceru-men obstructing the external auditory canal and tympanic membrane can lead to hear-ing loss.”

Method Determines Coding for Impacted RemovalIf cerumen is impacted, it may be removed by one of two general methods: lavage (irriga-tion) or instrumentation. For removal by la-vage, the correct code is 69209 Removal im-

pacted cerumen using irrigation/lavage, uni-lateral. For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 Removal impacted cerumen requiring instrumentation, unilateral. CPT® Changes 2016: An Insider’s View spec-ifies:

Code 69210 only captures the direct method of earwax removal utilizing curettes, hooks, forceps, and suction. Another less invasive method uses a continuous low pressure flow of liquid (eg, saline water) to gently loosen impacted cerumen and flush it out … Code 69209 enables the irrigation or lavage method of impacted cerumen removal to be separately reported…

You may report a single unit of either 69209 or 69210 (never both), per ear treated. As an example of proper reporting for 69209, CPT® Changes 2016: An Insider’s View provides the following:

A 7-year-old male child comes in for his well-child exam. He fails his hearing screen in the left ear. On examination, the physician is unable to see the tympanic membrane due to cerumen impaction. An order is placed for the nurse to irrigate the ear.

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Bilateral ServicesBoth 69209 and 69210 are unilateral pro-cedures. For removal of impacted cerumen from both ears, CPT® instructs us to ap-pend modifier 50 Bilateral procedure to the appropriate code. In the example above of the 7-year-old child, if irrigation occurred in both ears, appropriate coding would be 69209-50.When billing Medicare payers, different bi-lateral rules apply for 69210. The 2016 Medi-care National Physician Fee Schedule Rela-tive Value File assigns 69210 a “2” bilateral indicator. This means, for Medicare payers, the relative value units assigned to 69210 “are already based on the procedure being per-formed as a bilateral procedure.” In contrast to CPT® instructions, the Centers for Medi-care & Medicaid Services (CMS) allows us to report only one unit of 69210 for a bilater-al procedure. CMS does allow us to bill a bi-lateral procedure for cerumen removal by la-vage using 69209-50.Finally, note that some payers may stipulate “advanced practitioner skill” is necessary to report removal of impacted cerumen (i.e., payers may require that a physician provide 69209, 69210). Query your individual pay-ers to be certain of their requirements.

John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.

If cerumen is impacted, it may be removed by one of two general methods: lavage

(irrigation) or instrumentation.

External auditorycanal

Impactedear wax

The wax is extracted with a cerumenspoon or delicate forceps or by irrigation

One or both ears may be treated

Resource

www.aafp.org/journals/afp.html

AAO-HNS: www.entnet.org/

illustration 2015 © Optum 360

http://www.aafp.org/journals/afp.html

http://www.entnet.org/


HBO-AD

Quick Tip Category IIBy John Verhovshek, MA, CPC

In a Nutshell: Category II CodesCPT® Category II codes are a mystery for many coders. Although use of Category II codes is optional and not required for correct coding, reporting these codes may have advantages.The American Medical Association (AMA), which creates and main-tains CPT®, states that Category II codes “are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established perfor-mance measures and that have an evidence base as contributing to quality patient care.” For example, Category II codes:

… describe clinical components that may be typically includ-ed in evaluation and management services or other clinical services and, therefore, do not have a relative value associated with them. Category II codes may also describe results from clinical laboratory or radiology tests and other procedures, identified processes intended to address patient safety practic-es, or services reflecting compliance with state or federal law.

Per the California Quality Collaborative, assigning CPT® Catego-ry II codes:

• Lessens administrative burden of chart review for many

Healthcare Effectiveness Data and Information Set (HEDIS™) performance measures (HEDIS™ consists of 81 measures across five domains of care);

• Enables internal performance monitoring of key measures throughout the year, rather than once per year as measured by health plans and pay for performance; and

• Identifies opportunities for improvement, so interventions can be implemented to improve performance during the service year.

Category II codes are supplemental, and never are used in place of Category I or Category III codes.

Resources

CPT® Category II Codes: www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page?

CPT Category II Codes Tip Sheet: www.calquality.org/storage/documents/compass/CPTCategoryIICodeTipSheet.pdf

John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.

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By Michael Strong, MSHCA, MBA, CPC, CEMC

■ CODING/BILLING


Here is coding guidance to lift the weight from your shoulders.


CODING/BILLING

Arthroscopy

CODING/BILLING

The Centers for Medicare & Medicaid Ser-vices (CMS) and the American Academy of Orthopaedic Surgeons (AAOS) have oppos-ing views on shoulder anatomy. AAOS rec-ognizes the glenohumeral joint, the acro-mioclavicular (AC) joint, and the subacro-mial bursa as separate anatomic areas. CMS, by contrast, considers the shoulder to be a single anatomic region.

Understand the Differences and Challenges

Given these differences, coding arthroscop-ic shoulder surgery for providers who follow

AAOS guidelines can be challenging. For exam-ple: A surgeon performs a right, arthroscopic rota-

tor cuff repair with a distal claviculectomy, acromio-plasty, and debridement of the labrum. A subacromial

decompression is performed, with 1 cm removed from the distal clavicle.

Your first instinct may be to report CPT® 29827-RT Ar-throscopy, shoulder, surgical; with rotator cuff repair-Right side,

29824-RT Arthroscopy, shoulder, surgical; distal claviculectomy in-cluding distal articular surface (Mumford procedure), +29826-RT Ar-throscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary pro-cedure), and 29822-RT-59 Arthroscopy, shoulder, surgical; debride-ment, limited-Distinct procedural service. The problem with this coding is that 29822 bundles into 29827 and 29824, per Nation-al Correct Coding Initiative (NCCI) edits; and because this is the same shoulder, it’s inappropriate use a modifier to bypass the bun-dling edit.

Distal ClaviculectomyWhen determining whether the charges support 29824, you must review the records to determine:

1. Was the service performed on the shoulder arthroscopically?

2. Was the service performed on the distal clavicle?

3. Was approximately 1 cm removed?

If the answer is yes to all three of these questions, you may report 29824. If the answer is no to any question, a more appropriate code may exist. For example, bone removal of less than 8 mm is a debride-ment, such as CPT® 29822 or 29823 Arthroscopy, shoulder, surgical; debridement, extensive (see: AMA CPT® Changes: An Insider’s View 2002 and AAOS “April 2004 Bulletin”).If the provider is addressing the AC joint, coding may be more chal-lenging. If the surgeon notes creating a 1 cm space at the AC joint, he or she is referring to the distal end of the clavicle and the acromion. This is insufficient documentation to support either 29824 or 29826.

Subacromial Decompression with Partial AcromioplastyCPT® 29826 requires both a subacromial decompression and a par-tial acromioplasty. If acromioplasty is not performed, report only a debridement. Keep in mind that 29826 is an add-on code requir-ing a primary procedure. When coding the acromioplasty, look for discussion about the morphology (specifically type I, II, or III) in the operative notes. This determines if the acromion is flat, curved, or hooked.

NCCI Doesn’t Allow Modifiers for Same-Shoulder EditsUnder the National Correct Coding Initiative (NCCI) edits used by Medicare, Medicaid, some workers’ compensation payers, and some other commercial health payers, providers may never use an NCCI modifier, such as 59 Distinct procedural service, XE Separate encounter, XP Separate practitioner, XS Separate structure, or XU Unusual non-overlapping service to bypass the procedure-to-procedure edits in place for should surgery, unless the service is performed on the opposite shoulder. NCCI is required for use by Medicaid per the Affordable Care Act, and it has been adopted by 20 states for workers’ compensation. Many commercial carriers have also adopted NCCI, sometimes with modifications to reflect payer-specific medical policies and reimbursement methodologies.


CODI

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Returning to the AC joint: Was the creation of the 1 cm space in the AC joint due to a distal claviculectomy, acromioplasty, or both? If the bur was used to reshape the acromion by removing osteophytes or excess bone, this could be a form of debridement. If the acromioplasty is the only service performed, report a debride-ment (29822 or 29823). If acromioplasty is performed with distal claviculectomy, it’s possible the two procedures created the 1 cm space. In this situation, it may be appropriate to report 29824 or 29826, but not both.Encourage providers to describe the acromioplasty with morpholo-gy and the distal claviculectomy of approximately 1 cm separately, rather than to indicate the creation of a 1 cm space at the AC joint. This will reduce allegations of upcoding debridement, billing for services not rendered, or other false claim allegations.Example: If a 1 cm space is created by removing 7 mm from the distal clavicle and 3 mm from the acromion, this is a debridement (29822) because the documentation does not meet the minimum requirements for the distal claviculectomy or the acromioplasty. If the 3 mm removed from the acromion is a true acromioplasty — achieved by converting the acromion to a type I morphology with a subacromial decompression — proper coding is 29822 and 29826. The 7 mm does not meet the requirements of the claviculectomy. Documentation must support both services.

Rotator Cuff SurgeryThere are three possible codes for open rotator cuff surgery, depend-ing on whether it’s an acute or chronic repair, or if it’s a reconstruc-tion. CPT® 29827 is the only code for arthroscopic rotator cuff re-pair. If performing a revision or a reconstruction, modifier 22 Un-usual procedural service may be used to indicate the extensive work involved in the revision or reconstruction. Check with your payer, however, as they may require a different code for the arthroscop-ic rotator cuff reconstruction (e.g., 29999 Unlisted procedure, ar-throscopy).

DebridementDebridement is reported as either limited (29822) or extensive (29823). To report the extensive debridement, documentation must indicate anterior and posterior sites, multiple sites (usually three or

… coding arthroscopic shoulder surgery for providers who follow

AAOS guidelines can be challenging.

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CODING/BILLING

Arthroscopy


more), and/or abrasion chondroplasty. In comparison, limited de-bridement involves only a couple of sites.Example: A provider performs a subacromial decompression, bi-ceps tenotomy, and debridement of the anterior labrum. Proper coding is 29823. If the provider only performs two of the three pro-cedures, proper coding is 29822.

SLAP RepairsProviders must document the type of superior labrum from ante-rior to posterior (SLAP) to determine the correct code. There are four types of SLAP:

Type I is always 29822, which is a debridement.

Type III is either a debridement under 29822 or a SLAP re-pair under 29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion. Base your coding on the documentation. If the provider documents a type III repair, report 29807. If de-bridement is documented, report 29822.

Type II and IV are coded 29807. Documentation must be specific to the type and procedure performed to determine proper coding.

Unlisted ArthroscopyCPT® 29999 is often incorrectly reported for coracoid decompres-sion, biceps tenotomy, and microfracturing.The coracoid is connected to the acromion by the coracoacromi-al ligament. Release of the coracoacromial ligament is an inclusive component of 29826. The procedure does not require the release to be proximal to either the acromion or the coracoids; and because the code includes the coracoacromial ligament, it includes the cor-acoid process. Subacromial decompression without acromioplasty is considered debridement. Coracoid decompression is, likewise, a form of de-bridement. Coracoid decompression is included in 29826 when ac-romioplasty is performed; otherwise, it is considered debridement under 29822 or 29823, depending on the extent of the debridement.Biceps tenotomy (the removal of damaged tissue to promote heal-ing) also meets the definition of debridement (29822 or 29823).

The release of the biceps tendon allows the inflamed tissue to leave the shoulder joint and fall into the upper arm. Microfracturing is performed by drilling small holes (2-3 mm deep) into the bone to promote healing of healthy bone. Because anything less than 8 mm of a distal claviculectomy is considered debridement, 2-3 mm of microfracturing meets the definition of debridement for 29822 or 29823 (depending on the extent of the debridement).

Check Bundling, DocumentationMany arthroscopic shoulder surgeries are reported as debridement with 29822 or 29823; however, when performed with another ar-throscopic shoulder procedure on the same shoulder, the debride-ment is bundled into the primary surgical code(s) (if subjected to NCCI edits). Bottom line: Coders and providers must be aware of the documen-tation requirements for proper coding of shoulder procedures.

Resources:AAOS “April 2004 Bulletin:” www2.aaos.org/bulletin/apr04/code.htm

Michael Strong, MSHCA, MBA, CPC, CEMC, is the bill review technical specialist at SFM Mutual Insurance Company. He is a former senior fraud investigator with years of experience performing investigations into fraud and abuse. Strong also is a former EMT-B and college professor of health law and communications. He is a member of the St. Paul, Minn., local chapter, and can be contacted at [email protected].

Coders and providers must be aware of the documentation requirements for proper coding of shoulder procedures.



By Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC

■ CODING/BILLING


Make the Most of Hierarchical Condition Categories

Part 3: Learn from commonly under-coded conditions and documentation.

Accuracy and specificity in diagnosis cod-ing and medical documentation are criti-

cal in risk adjustment models. Over the past couple of months, we’ve looked at several un-der-coded conditions in the Medicare hier-archical condition category (HCC) risk ad-justment model and discussed documenta-tion strategies to improve coding. There’s one more batch of conditions we need to explore.

Vascular Disease

HCC 108Peripheral vascular disease (PVD) refers to any disease or disorder of the circulatory sys-tem outside of the heart or brain. Approx-imately eight million people in the United

States are afflicted with PVD. It’s most common in those over age 60, men,

and smokers.Approximately half of the

people diagnosed with PVD do not have

symptoms. The most common symp-tom is lower leg cramps with ac-tivity, which stop when rested. This is known as in-termittent clau-dication, and it

may occur in one or both legs. Oth-

er symptoms of PVD include color changes

to the skin on the legs and feet; coldness; thin, shiny

skin; hair loss on the legs; and weak pulses in the legs and feet.

To ensure correct code selection for PVD, look carefully at the documentation for the underlying cause (for example, arteriosclero-sis or diabetes). Note also any manifestations of PVD, including: ulcers, gangrene, claudi-cation, cellulitis, and amputation status. Remember: Risk adjustment coding is all about painting the most accurate, clinical picture of your patient.When documenting deep vein thrombosis (DVT), it’s important for the doctor to spec-ify “acute” or “chronic.” There is a separate code for long-term use of anticoagulants; an additional code for anticoagulation thera-py should be coded, as appropriate. An acute DVT is an emergency condition that is not usually treated in a doctor’s office. There is a “history of DVT” code for patients who have had a DVT in the past, but no longer have the acute condition (ICD-10-CM: Z86.718 Personal history of other venous thrombosis and embolism, ICD-9-CM: V12.51 Personal his-tory of venous thrombosis and embolism). Aneurysms without mention of rupture are also found in this category. Note that after an aneurysm has been documented as repaired, it’s no longer captured as an HCC. Do not report an aneurysm diagnosis when an ultra-sound is performed to rule out aneurysm. In this case, the sign or symptom should be cod-ed as the reason for the ultrasound.

Artificial Openings for Feeding or Elimination

HCC 188An ostomy is a surgically created opening connecting an internal organ to the outside of the body. This category includes “status

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of,” “attention to,” and “complications of” codes. It’s important to know the differences between these terms when selecting a code.Status codes indicate that a patient is a carrier of a disease, has a sequelae or residual condi-tion from a past disease or condition, or there is another factor influencing the patient’s health status. This includes such things as the presence of prosthetic or mechanical de-vices resulting from previous treatment. A status code is informative because the sta-tus may affect the course of treatment and its outcome. If the patient has a complication from an ar-tificial opening, such as infection or obstruc-tion, it’s accurate to code a complications code, versus a status code. Assign only the complication code. “Attention to” codes in-clude: adjustment or repositioning of a cath-eter, closure, reforming, and removal or re-placement of the catheter.When looking for the most appropriate code, confirm the ostomy is still present, as many artificial openings are temporary (e.g., gas-trostomy, ileostomy, colostomy). Some clues to look for in the documentation include “takedown,” “closure,” or “reversal.” These terms may indicate the ostomy status is no longer current.Documentation of a stoma may indicate the presence of an artificial opening. This cate-gory is for artificial opening status NG (naso-gastric) tubes. Port-A-Cath®, PICC (periph-erally inserted central catheter) line, indwell-ing urinary catheter (Foley), and chest tubes are not artificial openings because these are placed in natural openings.

Morbid Obesity

HCC 22Morbid obesity is a growing public health concern in the United States. Per ICD-10-CM Official Guidelines for Coding and Reporting, a diagnosis of a clinical condi-tion (i.e., overweight, obese, morbid obesity) must be obtained from provider documen-tation; however, the body mass index (BMI) may be coded from a dietician’s and/or other caregiver’s documentation. Providers should be cautioned against de-faulting to unspecified obesity for all patients because this is not a risk-adjusted condition and does not accurately reflect the clinical condition of patients with a BMI of 40, or higher. Some good documentation practices include: “diet discussed,” “exercise encour-aged,” and “dietician referral and/or coun-seling.” Under this category in ICD-10, there is an instructional note to use an additional code to identify the BMI (ICD-10-CM Z68-, or ICD-9-CM V85.-), if known.

Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC, is a risk coding and education specialist for Capital District Physician’s Health Plan. She enjoys teaching PMCC, auditing, and ICD-10 classes. Gianatasio is president of the Albany, N.Y., local chapter and a member of the National Advisory Board.

Risk adjustment coding is all about painting the most accurate, clinical picture of your patient.

To acknowledge the importance of risk adjustment methodologies to the future of our industry, AAPC has created a new credential, Certified Risk Adjustment Coder (CRC™). A CRC™ proves, by rigorous examination and experience, that she or he knows how to read a medical chart and assign the correct diagnosis codes for a wide variety of clini-cal cases and services for risk adjustment models, such as the CMS-HCC Risk Adjustment Model and others.


By Oby Egbunike, CPC, COC, CPC-I, CCS-P

■ CODING/BILLING


2016 Brings Opportunity to Increase Revenue

Prior to 2016, observation care services provided by clinical staff under the supervision of a physician or other qualified

healthcare professional were considered part of office or outpatient services. This year, two new add-on codes are available for reporting prolonged clinical staff observation services in the outpatient and office settings:

+99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)

+99416 each additional 30 minutes (List separately in addition to code for prolonged service)

These codes may be reported when the primary service provided to the patient by the physician or other qualified healthcare profession-al in an office or outpatient setting results in clinical staff providing

observation care beyond the typical time ordinarily included within the evaluation and management (E/M) service.

Note the DifferenceProlonged service codes +99354 Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual ser-vice; first hour (List separately in addition to code for office or other out-patient Evaluation and Management service) and +99355 Prolonged ser-vice in the office or other outpatient setting requiring direct patient con-tact beyond the usual service; each additional 30 minutes (List separate-ly in addition to code for prolonged service) require direct patient con-tact (face-to-face) between the physician and the patient. The new prolonged services codes are useful when the patient requires further clinical observation, but face-to-face time with the physician or oth-er qualified healthcare professional isn’t necessary.

Meet criteria to report two new codes for prolonged clinical staff observation services in the outpatient and office settings.


Prolonged Services

CODING/BILLING

Follow Examples for Applying CodesA 21-year-old male comes to his primary care physician’s office complaining of painful abdominal cramps and persistent diarrhea for the past two days. He has not been able to hold down any food or drink in 24 hours. The physician performs a detailed history, detailed examination, and medical decision-making of moderate complexity. The physician diagnoses the patient with viral enter-itis and decides to begin oral rehydration. The clinical staff mon-itors and observes the patient for three hours. Although the patient is still under the care of the physician, di-rect face-to-face time with the physician or other qualified health-care professional is no longer required — the clinical staff is un-der the supervision of the physician or other qualified healthcare professional. The total time of the primary service is used to determine when the prolonged service time begins, as shown here:

Total Duration of Prolonged Services (in Excess of Primary E/M Service)

Code(s)

Less than 45 minutes Not reported separately

45-74 minutes (45 minutes to 1 hour 14 minutes) +99415 x 1

75-104 minutes (1 hour 15 minutes to 1 hour 44 minutes)

+99415 x 1 and +99416 x 1

105 minutes or more (1 hour 45 minutes or more) +99415 x 1 and +99416 x 2 (or more, for each additional 30 minutes)

In the above example, the E/M service is reported with 99214 Of-fice or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key compo-nents: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. Prolonged services begin af-ter the 25 minutes of face-to-face time that is customary for the physician to spend with the patient during the primary service. CPT® +99415 is reported after clinical staff has spent at least 70 minutes face-to-face with the patient (45 minutes after the ini-tial 25 minutes).

Reporting CriteriaThe following criteria must be met to report +99415 and +99416:

1. The place of service must be in an office or outpatient set-ting.

2. Face-to-face time with the clinical staff must be beyond the typical face-to-face time of the E/M service on a given date (Note: Time does not have to be continuous).

3. The physician or qualified healthcare professional must be present to provide direct supervision of the clinical staff.

4. +99415 is for the first hour of prolonged clinical staff ser-vice on a given date (Note: A service of less than 45 min-utes total is not reported separately).

5. +99415 is for each additional 30 minutes.

6. Prolonged services of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately).

7. +99415, +99416 may not be reported for more than two si-multaneous patients.

8. Facilities may not report +99415 and +99416.

Resource

CPT® Professional Edition 2016

Oby Egbunike, CPC, COC, CPC-I, CCS-P, is a licensed ICD-10-CM instructor for AAPC. She has a Bachelor of Arts in Business Administration with concentration in Health Infor-mation Management from Northeastern University Boston. Egbunike has over 10 years of experience in healthcare management, coding, billing, and revenue cycle. She is the cod-

ing manager for professional coding and education at Lahey Health. Egbunike is a member of the Boston, Mass., local chapter.

The total time of the primary service is used to determine when the prolonged service time begins.

Vital DefinitionsClinical staff includes a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation, and facility policy to perform or assist in a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specific services.

Direct supervision means the physician or other qualified healthcare professional must be present at the site where the service is provided and is readily available to furnish assistance or direction.

To discuss this article or topic, go to www.aapc.com


By Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, CCS

Don’t Overlook Obstetric Panel Alternative

Quick Tip

CPT® 2016 introduced a new obstetric panel code, 80081 Ob-stetric panel (includes HIV testing), which is identical to the long-standing obstetric panel 80055 Obstetric panel, with one excep-tion: The newer code includes HIV testing.Required components for both codes include:

• Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004)

OR • Blood count, complete (CBC), automated (85027) and

appropriate manual differential WBC count (85007 or 85009)

• Hepatitis B surface antigen (HBsAg) (87340) • Antibody, rubella (86762) • Syphilis test, non-treponemal antibody; qualitative (eg,

VDRL, RPR, ART) (86592) • Antibody screen, RBC, each serum technique (86850) • Blood typing, ABO (86900)

AND • Blood typing, Rh (D) (86901)

To these tests, 80081 adds HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389). CPT® also specifically

instructs, “When syphilis screening is performed using a trepone-mal antibody approach [86780], do not use 80081. Use the indi-vidual codes for the tests performed in the obstetric panel.”Remember: When reporting a panel code, each test listed in the panel description must be performed. If any single test defined as part of a panel is not performed, seek out a different panel code (e.g., If an obstetric panel is performed without an HIV test and all other tests are performed, continue to report 80055). If no pan-el code properly describes the tests performed, report the code(s) to describe the individual tests performed, rather than the pan-el code. You may not report two or more panel codes including the same tests (for instance, you would never report 80081 and 80055 to-gether); however, you may report test(s) performed in addition to panel components. The American Medical Association’s (AMA) CPT® Changes 2016: An Insider’s Guide is careful to note, “The panel components are not intended to limit performance of other tests. If tests are performed in addition to the tests listed for a pan-el, the additional tests are reported separately in addition to the panel code.” This instruction is supported by guidelines within the CPT® codebook.

Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, CCS, is vice president, AAPC Mem-ber and Certification Development.

When reporting a panel code, each test listed in the panel description must be performed.

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Q When reporting radiology services, are transcription services con-sidered to be included in the technical component (TC) or the pro-fessional component (PC)?

A When defining professional and technical components for ra-diology services, the Centers for Medicare & Medicaid Servic-es (CMS) stipulates:

• The PC of a service is for physician work interpreting a diagnostic test or performing a procedure, and includes indirect practice and malpractice expenses related to that work. Modifier 26 is used with the billing code to indicate that the PC is being billed.

• The TC is for all non-physician work, and includes administrative, personnel and capital (equipment and facility) costs, and related malpractice expenses. Modifier TC is used with the billing code to indicate that the TC is being billed.

CMS’ definition does not clarify whether transcription services constitute “indirect practice and malpractice expenses” (PC) or “administrative, personnel and capital (equipment and facility) costs” (TC). The American College of Radiology (ACR), however, explicitly says that transcription is a technical cost:

Transcription costs for radiology and radiation oncology servic-es are reimbursed under the technical component and are never included in the professional component. The professional com-ponent for radiology services paid under the Medicare Physi-cians Fee Schedule (MPFS) is not intended to cover transcrip-tion costs. In addition, transcription costs are not included in the physician work valuation process. The professional component represents the physician’s professional services associated with their inter-pretation (via hand written or dictation etc.) and not transcrip-tion itself. Transcribing a report or transcription from a Dicta-phone is typically performed by administrative staff and not part of the physician interpretation/work.

Sources: Medicare Learning Network: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Radiology_FactSheet_ICN907164.pdf

ACR, Medicare Regulation FAQ-Transcription: www.acr.org/FAQs/Medicare-Regulation-FAQs-Transcription

CODING/BILLING

AAPC - Workshop

DEAR JOHN ■

Is Transcription a Technical or Professional Component?

In a Coding Quandary? Ask JohnIf you have a coding-related question for AAPC’s Healthcare Business Monthly, please contact Managing Editor John Verhovshek, CPC, at [email protected].

Workshop | March 16-31, 2016

Reimbursement Impactsin Shifting TimesThis workshop will address 4 hot button topics spawned by the Affordable Care Act that face healthcare business professionals in the current landscape:

Value-based purchasingMeaningful UseHierarchical Condition CodingPhysician Quality Reporting Standards

Can’t attend in-person?AAPC also offers virtual workshops visit www.aapc.com/workshops

www.acr.org/FAQs/Medicare-Regulation-FAQs-Transcription

www.acr.org/FAQs/Medicare-Regulation-FAQs-Transcription


■ AUDITING/COMPLIANCEBy Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA


2016 OIG Work Plan: Part A Risk Areas

The Office of Inspector General’s (OIG’s) annual work plan for 2016 indicates significant new areas, as well as ongoing target areas, on which the federal agency will focus its reviews and au-dits of U.S. Department of Health and Human Services (HHS) programs and operations this year. Let’s take a look at what’s under the OIG’s microscope for facilities submitting claims to Medicare Part A.

What’s New for 2016Review of the OIG work plan is a critical element to any compli-ance program. For 2016 and beyond, OIG continues to focus on

emerging payment, eligibility, management, and information technology systems security vulnerabilities in Affordable Care Act programs.

Hospital-related Policies and PracticesFor hospital-related policies and practices, the OIG is focusing on:

• Reconciliation of outlier payments• Outpatient/Inpatient stay reporting under the two-

midnight rule• Medicare costs associated with defective medical devices

Put these OIG compliance efforts on a high priority focus list at your hospital.


AUDITING/COMPLIANCE

OIG Work Plan

• Analysis of salaries included in hospital cost reports• Comparison of costs for services provided in provider-

based and freestanding clinics

REVISED! Medicare oversight of provider-based status – OIG will determine the number of provider-based facilities that hospitals own and the extent of methods the Centers for Medicare & Medicaid Services (CMS) has to oversee provider-based billing. Provider-based status allows facilities owned and operated by hospitals to bill as hospital outpatient departments. Provider-based status can result in higher Medicare payments for services furnished at provider-based facilities and may increase beneficiaries’ coinsurance liabilities. The Medicare Pay-ment Advisory Commission (MedPAC) has expressed concerns about the financial incentives presented by provider-based status and stated that Medicare should seek to pay similar amounts for similar services.

Hospitals – Billing and PaymentsFor facility billing and payments, the OIG is focusing on:

• Inpatient claims for mechanical ventilation• Compliance with selected inpatient and outpatient billing

requirements• Duplicate graduate medical education payments• Indirect medical education payments• Outpatient dental claims• Nationwide review of cardiac catheterizations and

endomyocardial biopsies• Payments for patients diagnosed with kwashiorkor• Bone marrow or stem cell transplants• Review of hospital wage data used to calculate Medicare

payments• Intensity modulated radiation therapy

NEW! Medical device credits for replaced medical devices – Federal regulations (see 42 CFR §§412.89, 419.45) require reductions in Medicare payments for the replacement of

implanted devices. OIG has determined that Medicare admin-istrative contractors have made improper payments to hospitals for inpatient and outpatient claims for replaced medical devices. If your facility or organization has been paid improperly, you should voluntarily disclose and refund any overpayments.

NEW! Medicare payment during the Medicare severity diagnosis-related group (MS-DRG) payment window – OIG will initiate a review of Medicare payments to acute care hospitals to determine whether certain outpatient claims billed to Medicare Part B for services provided during inpatient stays were allowable under the Inpatient Prospective Payment System. Certain items, supplies, and services furnished to inpatients are covered under Part A and should not be billed separately to Part B. Facilities should review any payments from Part B to determine if such payments were appropriate. Overpayments should be disclosed and refunded.

Hospitals – Quality of Care and SafetyRegarding quality of care and safety measures in facilities, the OIG is focusing on:

• Inpatient rehabilitation facilities — adverse events in post-acute care for Medicare patients

• Long-term care hospitals — adverse events in post-acute care for Medicare patients

• Hospital preparedness and response to high-risk infectious diseases

• Hospitals’ electronic health record system contingency plans

NEW! CMS validation of hospital-submitted quality reporting data – OIG will determine the extent to which CMS validated hospital inpatient quality reporting data. CMS uses reported quality data for the Hospital Value-based Purchasing Program and the Hospital Acquired Condition Reduction Program, which account for future payment rates; therefore, so their accuracy and completeness are important.


OIG Work Plan

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Nursing HomesOIG will report on the implementation status and early results for the CMS National Background Check Program for long-term care employees from the first four years of the program.

NEW! Skilled Nursing Facility (SNF) Prospective Payment System requirements – Prior OIG reviews have found that Medicare payments for therapy greatly exceeded SNFs’ cost for therapy. In addition, OIG has determined that SNFs have increasingly billed for the highest level of therapy even though key beneficiary characteristics remained largely the same. OIG, relying on conformance with documentation requirements, will determine whether SNF care was reasonable and necessary. Such SNF documentation includes:

1. A physician order at the time of admission for the resi-dent’s immediate care;

2. A comprehensive assessment; and

3. A comprehensive plan of care prepared by an interdisci-

plinary team that includes the attending physician, a reg-istered nurse, and other appropriate staff.

SNFs should review past therapy payments and initiate a vol-untary disclosure and refund of any improper payments. Going forward, they should review published Medicare guidance to ensure compliance.

Home HealthFor home health, the OIG is honing in on:

• Home Health Prospective Payment System requirements

Get to Know the OIG Work PlanThis is a mere summary of the Part A portion of the 80-page work plan. For details pertaining to ongoing reviews, which are listed above only by name, or for details regarding risk areas associated with Part B, Part C, Part D, and Medicaid programs, please refer to the 2016 OIG Work Plan.

Note: We’ll address the new and revised focus areas applicable to Medicare Part B providers in an upcoming issue.

For each focus area affecting your facility, be certain to review appropriate CMS interpretive guidance and local coverage determinations, as well as other Medicare regulations, publica-tions, and guidance referenced. This will help you to completely understand and comply with CMS expectations — particularly with respect to documentation content.

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of AAPC’s National Advisory Board, serves on AAPC’s Legal Advisory Board, and is AAPC Ethics Committee chair. He is admitted to the practice of law in California as well as to the bar of the U.S. Supreme Court and the U.S. district courts in the southern district of California and the western district of Pennsylvania. Miscoe has over 20 years of experi-

ence in healthcare coding and over 18 years as a forensic coding and compliance expert. He has provided ex-pert analysis and testimony on coding and compliance issues in civil and criminal cases and represents healthcare providers in post-payment audits and HIPAA OCR matters. Miscoe speaks on a national level, and is published nationally on a variety of coding, compliance, and health law topics. He is a member and past president of the Johnstown, Pa., local chapter.

History in the MakingThe Office of Inspector General (OIG) pursues perceived areas of fraud, waste, and abuse based on its obligation to protect the integrity of U.S. Department of Health & Human Services (HHS) programs through audits and suggested improvements to HHS programs. As evidence of its continued emphasis on recoveries, OIG reported expected recoveries in 2015 of more than $3 billion, comprised of $1.13 billion in audit receivables and approximately $2.22 billion in investigative receivables. OIG also estimates approximately $20.6 billion in savings for 2015 based on prior legislative, regulatory, or administrative actions supported by OIG recommendations.

Besides the recovery figures, OIG reported exclusions of 4,112 individuals and entities (up from 4,017 in 2014), 925 criminal actions (down from 971 in 2014), and 682 civil actions (533 were filed in 2014). The civil actions included false claims or unjust enrichment lawsuits, civil monetary penalty settlements, and administrative recoveries relative to provider self-disclosure matters.

There is no slowdown in OIG’s willingness to use exclusions and civil or crimi-nal prosecution to achieve its goals. For this reason, compliance efforts must be a high priority for entities submitting claims to federally funded healthcare programs.

There is no slowdown in OIG’s willingness to use exclusions and civil or criminal prosecution to achieve its goals. … compliance efforts must be a high priority for entities that submit claims to federally funded healthcare programs.

Resource

2016 OIG Work Plan: http://oig.hhs.gov/reports-and-publications/archives/workplan/2016/oig-work-plan-2016.pdf

www.aapc.com February 2016 47

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■ AUDITING/COMPLIANCEBy Stacy Harper, JD, MHSA, CPC, and Chandler Carr


Be sure the practitioner is authorized to practice in your state and requirements are met.

When working in an organization that bills for services performed by a nurse practitioner (NP) or physician assistant (PA), discussion may arise regarding limitations on the scope of practice for these non-physician practitioners (NPPs).

Medicare provides coverage for services performed by NPs and PAs when certain requirements are met. One of those requirements is that the practitioner is legally authorized to perform the services in the state in which they are provided. Medicare regulations comply with the applicable state law.

Define Scope of PracticeScope of practice laws and regulations define the activities, includ-ing procedures, that a practitioner is authorized to carry out under his or her licensure. For NPs and PAs, these definitions vary in some notable ways among states.

Beyond the specific laws and guidance implemented by a state, an NP’s or PA’s practice may be further limited by the supervising phy-sician’s specific terms and delegation. For example, the determina-tion of certain procedures or services that can be performed by the

Get the Scoop on NPP Scope of Practice


AUDITING/COMPLIANCE

Scope of Practice

PA or NP may be specified in the statute or regulation, but in many states it’s de-termined and incorporated into a written agreement or policy by the physician who is supervising the NP or PA. This means, even within a state, there may be scope of practice variations among organizations.

When identifying scope of practice, there are certain areas where state-specific variations are found. These may include:

Whether the NP may practice independently of physician involvement. In a slim majority of states, NPs may diagnose and treat patients without direct physician involvement. These laws vary in the scope of autonomy they grant to NPs. In New York, for example, not only are NPs held independently responsible for the diagnosis and treatment of patients without direct physician supervision, but NPs with 3,600 hours of practice can opt to practice under “collabora-tive relationships” with physicians. The collaborative relationship is defined as communication (including electronic) with a physician to exchange information or make referrals. These collaborative relationships do not require the NP to have a written agreement with a physician, to have a physician co-sign or review records or orders, or to be supervised in person.

Other states do not have this level of autonomy. In Missouri, for example, the NP is authorized to treat only in collaboration with a physician under a written agreement, must remain within a certain distance of the supervising physician, is subject to review and consultation with the physician every two weeks, and can provide

only a limited scope of treatment in the absence of a follow-up visit with a physician.

The scope of authority to prescribe medications. A very narrow majority of states do not allow an NP to prescribe medications without physician involvement. Typically, in these states, which include California and Texas, an NP must have a collaborative agreement in place with a physician to prescribe medications. Other states, such as Arizona and Washington, allow NPs to prescribe medications without physician involvement. Prescriptive authority may also vary from state to state as to whether the supervising physician retains responsibility for prescriptions issued by an NP.

Prescription authority may be even more restrictive for PAs. In most states, a PA is authorized to prescribe medications under physician supervision, but the supervising physician may limit this prescrip-tive authority. Some states limit the extent to which a physician may delegate prescribing to a PA. For instance, in Georgia, PAs may not prescribe schedule II drugs (controlled substances). Other states are even more restrictive: in Kentucky and Florida, PAs generally may not administer or schedule drugs.

How the scope of services is defined. In most states, the physician and NP or PA establish the procedure and services within the scope of practice in a written agreement. Historically, this was not the case, and scope of practice laws defined the precise procedures an NP or a PA was authorized to perform. Some states still establish the scope of practice in this fashion. In these states, there may also be variation, depending on the type of facility in which services are performed. In Ohio, for example, a PA’s scope of practice is determined based on the facility type and state law specifies certain permitted or prohibited processes while retaining broader consider-ations of facility policy.

Limits on the number of NPs or PAs a physician may supervise. Most states have some limit on the number of NPs or PAs a physician may supervise. Illinois and Washington, for example, allow a physician to supervise up to five PAs. In Mississippi, a physician can only


Scope of Practice

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supervise up to two PAs, but cannot supervise any PAs while supervising two NPs. In states such as Massachusetts and North Carolina, there is no numerical limit.

Requirements of a collaborative practice or supervision agreement. Perhaps the greatest variation among states arises in the specifics on what must (or may) be provided for in a written agreement between an NPP and the supervising physician. Generally, state law may require these agreements include provisions such as:

• Scope of practice. Although this may be statutorily defined, in most cases, the scope of practice should be established in the agreement.

• Prescriptions. Often a drug protocol is necessary to identify medication types and indications the practitioner may prescribe.

• Availability and consultation. Because scope of practice laws generally provide some level of supervision by a physician over the practitioner, the scope of these responsibilities should include when the physician must be consulted and the extent to which the physician must be available when the NP or PA is providing services, consistent with state law.

• Documentation review. Some states require the written agreement to include a periodic review of NP or PA documentation by the supervising physician.

Know the Impact of Scope of PracticeDetermining scope of practice is no mere formality. Treating patients using procedures not provided for or allowed in the state’s scope of practice law constitutes as practicing medicine without a license, or unprofessional conduct, and may subject the practitioner to disciplinary actions or judicial proceedings. Because scope of practice is incorporated in Medicare regula-tions, billing for a service provided outside an NPP’s scope of practice may create an overpayment or false claim liability.

When determining the scope of practice for an NP or PA, you should take the following steps:

1. Identify and review the state law for each state where the services will be provided. Because of variances between states, problems may arise when an organization expands into a new state.

2. Consider practitioner-specific requirements. The laws reg-ulating an NP are separate from the laws regulating a PA.

In most states, the physician and NP or PA establish the procedure and services within the scope of practice in a written agreement.

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AUDITING/COMPLIANCE

Scope of Practice

Treating patients using procedures not provided for or allowed in the state’s scope of practice law constitutes as practicing medicine without a license, or unprofessional conduct, and may subject the

practitioner to disciplinary action or judicial proceedings.

Your organization should ensure it considers the laws ap-plicable to the license held by the NPP. If an organization replaces an NP with a PA, this may significantly affect the scope of practice.

3. Review the collaborative practice or supervision agree-ment. Because many states allow discretion to the super-vising physician in determining the scope of services to be delegated, it’s important for the organization to under-stand how this delegation may have been limited by the physician.

4. Establish processes for patient care that ensure the NP or PA will provide services within the authorized scope of practice.

5. Create a process to identify and resolve exceptions. This is especially important if you are in a state that requires a high level of involvement by the supervising physician.

By establishing processes consistent with the authorized scope of practice for an NP or PA, your organization can protect the licensure of staff and improve compliance with billing obliga-tions and coverage of services.

Stacy Harper, JD, MHSA, CPC, is a healthcare regulatory attorney with the law firm of Lathrop & Gage, LLP. She serves on AAPC’s Legal Advisory Board and formerly served on the National Advisory Board. Harper regularly counsels healthcare providers related to complex billing and coding standards, Medicare participation and payment require-ments, Stark, Anti-kickback, HIPAA, and other state and federal healthcare laws. She is a member of the Kansas City, Mo., local chapter.

Chandler Carr is a general healthcare law attorney and associate with the law firm of Lathrop & Gage, LLP. Chandler advises clients on matters such as HIPAA compliance, licen-sure issues, and compliance with Medicare fraud and abuse laws.

Resources

42 C.F.R. §§410.74 & 410.75.

Sermchief v. Gonzales, 660 S.W.2d 683 (Missouri 1984).

Missouri - RSMo. §334.735 et seq.

Georgia - Physician Assistant Act, O.C.G.A. §43-34-100 et seq.

Kentucky - KRS §311.840 et seq.

Florida - Florida Statute §458.347 et seq.

Ohio - RC §4730.01 et seq.; Ohio Administrative Code 4730-1 et seq. (http://codes.ohio.gov/oac/4730-1)

Illinois - Physician Assistant Practice Act of 1987, 225 ILCS 95/1 et seq.

Washington - RCW 18.71A.010 et seq. and 18.79.050 et seq.

North Carolina - NCGS. §90-9.3; 21 NCAC 32S.0201 et seq.

Massachusetts - 263 CMR 5.00 et seq.: Scope of Practice and Employment of Physician Assistants.

Mississippi - Mississippi Code of 1972 Annotated §73-26-

1 et seq. (2013); Mississippi Administrative Code 30-17-2615:1.1 et seq.

New York - Nurse Practitioners Modernization Act, N.Y. Education Law §6902.

Arizona - ARS. §32-1601 et seq.; A.A.C. R4-19-501 et seq.

Texas - Texas Administrative Code 22 §221.1 et seq.

California - California Business & Professional Code §2834 et seq.

Pennsylvania - 63 Pennsylvania C.S. §218.1 et seq.


■ AUDITING/COMPLIANCEBy Judy Harris-Guay, CPC


Be Aware of Your Payers’ Teaching Physician GuidelinesDig in to “Test Your Knowledge of Teaching Physician Guidelines” for clarification.Because Medicare is a national program, one might expect the billing and documentation rules to be the same in all 50 states. As healthcare business professionals, however, we know this is not the case. In the article “Test Your Knowledge of Teaching Physician Guidelines” (September 2015), we tested your knowledge of teach-ing physician guidelines. Now, let’s expand your knowledge even further.

Evaluation and Management (E/M) ServicesRelative to what the teaching physician must document to comply with the Centers for Medicare & Medicaid (CMS) rules for E/M services, a statement such as, “I saw and evaluated the patient. I agree with the resident’s documentation” may be acceptable in some states. But in other states, the Medicare administrative contractor (MAC) would consider this to be a generic attestation, and require the teaching physician to personalize the documentation to the specific patient and the teaching physician’s role in the plan.

CMS does not require the teaching physician to see every Medicare patient. Based on the experience level of the resident, it’s not always necessary for the teaching physician to render services when the resident has already seen the patient. Some MACs require more than a generic attestation (“macro” or “smart phrase”) to support the teaching physician’s services. The statement, “I saw and evalu-ated the patient with the resident” is an acceptable smart phrase for the teaching physician to use in the electronic health record, if the teaching physician adds patient-specific details of the plan.

The level of E/M billed should reflect what was medically necessary for the patient, and not necessarily the level required and docu-mented for teaching purposes.

Given that, the 2nd, 4th, 5th, and 15th examples in “Test Your Knowledge of Teaching Physician Guidelines” may need to include a personalized teaching physician note, depending on your MAC.

Regarding medical students, a teaching physician may only use the medical student’s review of systems and past family social history. A teaching physician may not use a teaching physician attestation when working with a medical student.

Time-based BillingThere are specific requirements the teaching physician must meet when billing for critical care. Key elements that must be documented include:

• The time the teaching physician spent providing critical care; • That the patient was critically ill during the time the teaching

physician saw the patient; • What made the patient critically ill; and • The nature of the treatment and management provided by the


AUDITING/COMPLIANCE

Teaching PhysiciansTo discuss this article or topic, go to www.aapc.com

teaching physician. The medical review criteria are the same for a teaching physician as for all other physicians (see CMS Transmittal 1548).

CPT® explains that the level of certain E/M services may be selected using time as the determin-ing factor if over 50 percent of the total visit time was spent in counseling or coordinating care. Note, however, that some MACs (and even private insurers) may no longer accept documentation of a “50 percent” statement and total visit time. Some payers require two specific times to be documented in the medical record: the time spent counseling and the total time of the visit. As a best practice, providers should include both times.

Procedures“Test Your Knowledge of Teaching Physician Guidelines” provided an example (No. 10) in which, “The general surgery resident documents the hernia repair and states the attending physician was present for the entire surgery. The attending co-signs the note,” and concludes that this is acceptable documentation because “The guidelines state that if the teaching physician is present the entire time, a resident or operating room nurse can document the entire encounter, including the teaching physician’s presence.” Note that the teaching surgeon must also sign either the operative note or her

or his own progress note. Unless the surgeon’s signature is present, outside auditors may consider the service to be an overpayment.

For overlapping surgeries (e.g., “Test Your Knowledge of Teaching Physician Guidelines,” No. 12), the teaching surgeon must indicate the qualified surgeon who was available to immediately assist the resident. Medicare Carriers Manual section 100.1.2 (revision 1859) states, “When a teaching physician is not present during the non-critical or non-key portions of the procedure and is participating in another surgical procedure, he or she must arrange for another qualified surgeon to immediately assist the resident in the other case should the need arise.”

“Test Your Knowledge of Teaching Physician Guidelines” No. 13 provided a scenario in which a family medicine resident sees an established patient for follow-up of his hypertension and to receive a knee injection to relieve pain cause by osteoarthritis. The resident documents the encounter, including the injection administration. The attending documents, “I saw and examined the patient. I agree with the resident’s note.”

In this case, you may be able to bill the visit if your MAC doesn’t require a personalized teaching physician note; however, you cannot bill the injection because the teaching physician does not state that he or she was present for the injection.

Judy Harris-Guay, CPC, has been the director of medical billing and research compliance at Yale University School of Medicine for 18 years. She is the author of “Ready, Set, Comply” (first edition) and owner of the Compliance Audit Tracking System, LLC. Harris-Guay is a member of the New Haven, Conn., local chapter.

Some payers require two specific times to be documented in the medical record: the time

spent counseling and the total time of the visit.

Resources

CMS Transmittal 1548: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5993.pdf

Medicare Claims Processing Manual, section 100.1.2, revision 1859, Nov. 20, 2009; implemented Jan. 4, 2010: www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1859CP.pdf

image by iStockphoto © vadimguzhva

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5993.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5993.pdf


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This is the only specialty series that comes straight from the source of CPT code—the AMA—and exclusively provides the CPT Editorial Panel’s Guidelines instructions on ICD-10-CM documentation and coding.

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To learn more, visit amastore.com or call (800) 621.8335.


By Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT

PRACTICE MANAGEMENT ■


Medical coding and billing professionals must work together to re-duce the amount of unpaid claims in a practice. As an account

ages, it is less likely to be paid. Aged and unpaid medical billing ac-counts cost the practice money. With proper coding, fast claims sub-missions, and a good understanding of the claims life cycle, adjudica-tion, tracking, appealing, and collections, you can reduce the amount of aged claims in a medical practice.

Manage Office ClaimsThe basic steps of managing a medical billing claim are:

• Verify the patient’s registration information, including identification and health insurance benefits.

• Collect the copayment and, if you know there will be co-insurance, try to collect it up front.

• Generate a patient encounter form. I cannot stress enough: Do your best to collect co-insurance and co-payments up front. This reduces the issue of trying to collect later as a claim gets older (and older, and older).

Claims Life CycleAfter the patient encounter, coders should assign the proper codes to tell the story of what happened during the encounter. All CPT®, HCPCS Level II, and ICD-10-CM codes should be assigned imme-diately and properly.To show medical necessity, ensure all diagnosis and procedure codes are supported by clinical documentation in the patient’s medical re-cord. This avoids claim denials and resubmissions, and helps to elim-inate the issue of aging unpaid claims. Total charges for procedures and services on the patient encounter form. Post all charges to the patient’s ledger or account record and on the daily accounts receivable record. This can be done manually or using in-office practice management software (which nearly all prac-tices are using now). If there’s uncertainty about the coding (it happens), call the payer and ask for guidance. This reduces the time, energy, and expense of going through resubmissions and appeals. Next, it’s time to bill the patient’s insurance carrier. Attach to the claim any supporting documentation, such as copies of medical re-ports, authorizations, pathology reports, etc. Always ask the payer how it wants attachments to be submitted. If the patient has a co-insurance amount not collected up front, bill the patient now.If you are manually processing, obtain the provider’s signature. If fil-

Don’t Let Medical Billing Accounts Grow OldTime is ticking: Target and manage unpaid claims now to increase revenue.


Medical Billing

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ing electronically, the physician’s EDI number and password serve as signature. File a copy of the claim in the provider’s insurance files, or in the computer if using electronic claims. Log the complet-ed claim in the insurance registry. Software will generate a claims log for you. At this point, the life cycle of the claim starts, which is claims sub-mission, claims processing, claims adjudication, and payment.

Claims AdjudicationFor proper claims adjudication, the claim must contain the required information (patient information, proper coding for medical neces-sity, proper documentation in the patient record, etc.). The claim cannot be a duplicate or it will be rejected. Verify that payer rules and regulations have been followed and that the claim covers the services provided and documented.

Claims FilesLet’s backtrack to discuss claim files. Claim files should contain open claims, closed claims, and remittance advice files. Open claims are filed by month and insurance carrier. Closed claims are filed by the year and insurance carrier, after all processing and ap-peals have been completed. The remittance advice files are filed ac-cording to the date of service; this is due to the batch remittance advice, which may contain the results for many patients/claims at once.

Tracking ClaimsTracking claims diligently is key to avoiding aged claims. A medi-cal billing professional will maintain a copy (electronic or paper) of each submitted claim, and they will review the remittance advice to make sure that the claim was paid accurately. If there is a non-pay-ment issue, draft an appeal and resubmit the claim.

Appealing DenialsTo reduce the amount of aged claims, it’s important to submit ap-

peals right away. Do not hold onto them for 30, 60, or 90 days’ time. Common reasons for denials include:

• Services were deemed not medically necessary: Ensure medical necessity is documented. If not, request the physician to append the medical record with the necessary information to support the coding.

• Pre-existing condition: Under the Affordable Care Act, health insurance companies can’t refuse coverage just because of a pre-existing condition.

• Non-covered benefit: Check the patient’s benefits before treatment.

• Termination of coverage: Verify coverage prior to the encounter.

• Failure to obtain pre-authorization (when required).• Out-of-network provider was used: Call the payer first.• Incorrect codes: Even the best medical coders sometimes

make a mistake. Learn from your mistakes to reduce the


To discuss this article or topic, go to www.aapc.com Medical Billing

PRACTICE MANAGEM

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amount of aged claims your practices has. Fix the mistake and resubmit the claim immediately.

• Claim contained incomplete information: Make sure all required information is supplied (patient information, physician information, etc.).

Collections: Steps for SuccessAlthough it’s best to collect all coinsurance, copayments, etc., from the patient on the date of service, sometimes the patient requests to be billed. To reduce aged claims, focus on the newest claims first. Do not ig-nore aged claims, but initially pursue those claims most likely to pay out for the practice. When looking over aged claims, always:

• Verify health carrier and identification cards.• Determine the coverage for each patient to avoid denials

based on “it’s not covered.”• Check claims for errors before submitting.• Make sure the carrier received the claim.

• Review records to see if the claim was paid, denied, or is pending.

Submit supporting documentation requested by the payer to sup-port the claim. To collect on a claim, call the patient within one week after the encounter, mail a copy of the invoice 10 days after the due date, mail a reminder two weeks after the invoice, and make at least one collection call to determine the reason for delinquency. If necessary, mail a collection letter. Usually two or three collection letters are mailed before taking further action. If necessary, make a few more telephone calls in an attempt to collect, or submit the claims to the office’s collection service. Taking these steps as quick-ly as you can reduces the need to call in an outside collection agency.

Let It GoBad (i.e., uncollectable) debts can usually be written off. Don’t keep trying to collect on a bad debt, which can cause you to “throw good money after bad.” In the end, it’s cheaper to let it go. Work smart and organize your time. Aged claims and bad debt, along with fraud and abuse, are downfalls of many medical prac-tices. Doing things right the first time will reduce the amount of aged claims in your system. If there’s too much work for one per-son, speak to the office manager about hiring someone to assist the medical biller or perhaps hiring a second medical biller. There is no shame in needing assistance. Providers will see the advantage of hir-ing additional help if it means increasing revenue.

Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT, has worked for more than 10 years in the online adult education industry, teaching medical transcription, medical coding, medical billing, and legal program, and she is a course content writer. Moreno has been published in industry publications, and has written content for online medical transcription

and medical coding programs. She writes for her local AAPC chapter in Albuquerque, N.M. Moreno’s passion is in helping adults learn new career skills to better their lives; her motto is: “You are never too old to learn something new.”

Work smart and organize your time. Aged claims and bad debt, along

with fraud and abuse, are downfalls of many medical practices.


■ WANT TO WRITE?

Writing for Healthcare Business Monthly can be a rewarding experience.

By Michelle A. Dick

AAPC’s membership of healthcare business professionals thrives on sharing know-how through networking, presenta-

tions, webinars, and writing. Most of the content in Healthcare Busi-ness Monthly is submitted by AAPC members. We encourage you to send your original articles on subjects in which you excel for the pur-pose of educating fellow members.

Guidelines to Make It EasyTo make the editing process run smoothly, we ask all of our contrib-utors* to follow a few guidelines:

• Format – Articles should be submitted electronically as a Word Document. We cannot publish PowerPoint presentations, but we can help you turn them into articles.

• Length – Articles should be between 500 to 2,000 words. If your article runs longer than 2,000 words, you may want to break it into two articles.

• Citations or sources – Make sure you quote anything that is not in your own words. List the source separately after the article or attribute sources in the text. You may include website URLs in your article.

• Codes – On the first use in your article, CPT®, ICD-10-CM, or HCPCS Level II codes must be accompanied with full code descriptions. Avoid confusing your readers by paraphrasing descriptions or using unofficial short descriptions.

• Acronyms – Spell out acronyms and abbreviations on first use. Not everyone is familiar with the acronyms and abbreviations unique to your specialty.

• About you – Include a 50-word or less biography at the end of the article and a digital photo for each author. Be warned that photos taken off the Web are usually low resolution and don’t print well, so send the original photo before it was adjusted for the Internet. Send the photo as a separate attachment from the Word Document.

For editorial consistency throughout our publications, AAPC uses the Associated Press Stylebook, Chicago Manual of Style, American Medical Association (AMA) Manual of Style, and AAPC Official Style Conventions as the final word on editorial style and grammar. (You don’t need to know these guidelines. That’s our editors’ job!*)You may be eligible for continuing education units (CEUs) for writ-ing. To be eligible, you must be credentialed, and the article must be a minimum of 500 words. Typically, we only offer CEUs for articles that provide clinical guidance for coding, billing, compliance, etc. If you are eligible to receive CEUs, you’ll receive them several weeks af-ter your article is published and mailed to members.

Don’t Sweat the Small StuffDon’t let your inexperience in writing stop you from sharing your experience in the business of healthcare. Our editors will help you make your article look its best. If you’re unsure about where a comma should go, or if you should use “then” or “than,” don’t worry about it — we’ve got you covered. Send your healthcare business-related articles to John Verhovshek, CPC, at [email protected] or your member-related arti-cles to Michelle Dick at [email protected].

Share Your Expertise & Write for HBM

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CPC-AAnn Countryman, CPC-AAnn Fayette, CPC-AAnn Horner, CPC-AAnn Mickelsen, CPC-AAnna Burnham, COC-A, CPC-AAnna Cerqueira, CPC-AAnna Hawk, CPC-AAnna Kelemen, CPC-AAnna Lopez, CPC-AAnne-Marie Nelson, CPC-AAnne-Marie Gray, CPC-AAnnette Diaz, CPC-AAnnette Goetsch, CPC-AAnnette Nagle, CPC-AAnnette Parr, CPC-AAnoop Singh, CPC-AAnshika Verma, CPC-AAntoinette Chiridza, COC-AAnup Kumar Bebarta, CPC-AAnusha Yarlagadda, CPC-AApril Rosenberger, CPC-AApti Joshi, CPC-AAraseli Bachmann, COC-AArchana K, COC-AArica Oliver, CPC-AAriel R. Portilla, CPC-AAriely Aniles, CPC-AArismayra Padron, CPC-AArkin Diesta, CPC-AArumugakumar Murugan, COC-AArun P.L, COC-AAshlee Wallace, CPC-AAshley Anne Mills, CPC-AAshley Anne Mills, CPC-AAshley Emelander, CPC-AAshley Johnson, CPC-AAshley Knight Young, CPC-AAshley Scarbeau, CPC-A

Ashley Strausbaugh, CPC-AAsiq Ahamed, CPC-AAthira Prem, CPC-AAtul Kumar Gautam, CPC-AAudra Villalobos, CPC-AAutumn Stall, CPC-AB. Vijay Kumar, CPC-ABalachandra Gururaj, CPC-ABalessa Quinonez, CPC-ABandana Panda, CPC-ABandana Rana, COC-ABarbara Diane Joseph, CPC-ABarbara Patton, CPC-ABecki Horton, CPC-ABelinda Murchison, CPC-ABerkely Morin, CPC-ABeth Dummer, CPC-ABethany Robbins, CPC-ABetty Cook, CPC-ABhavani Thota, CPC-ABhavini Gandhi, CPC-ABibin B C, COC-ABindhu Shashikumar, CPC-ABipin Kumar, CPC-ABlair Cotterman, CPC-ABlake Alter, CPC-ABonita G Davenport, CPC-ABonnie Clift, CPC-ABonnie Marinelli, CPC-ABranden Butcher, CPC-ABrandi Kowalinski, CPC-ABrandon Puente, CPC-ABrandy Parduhn, CPC-ABrenda Kay Atkielski, CPC-ABrenda Mathews, CPC-ABrenda S Bialy, CPC-ABrenda Stopper, CPC-ABrenda Uetz, CPC-ABrendan McAndrew, COC-ABrenna Burns, CPC-ABrent Abraham, CPC-ABrian Koga, CPC-ABriana Lueker, CPC-ABrianna Beatty, CPC-ABrianne Breese, CPC-ABridget Kampen, CPC-ABridget Morris, CPC-ABritta Petersen, CPC-ABrittany Pruitt, CPC-ABrittney Slayton, CPC-ABrooke DePriest, CPC-ABrooke Elizabeth Shafer, CPC-ACaitlin Theresa Eliaszewskyj, COC-ACamille Sanderson, CPC-ACaree Davis, CPC-ACareeza Corpuz, CPC-ACari Tobar, CPC-ACarla Melton, CPC-ACarla Thompson, CPC-ACarlie Falk, CPC-ACarlos Ernesto Cabrera, CPC-ACarlos Pires, CPC-ACarlos Resto, COC-ACarmen Calderon, CPC-ACarmen N. Herrick, CPC-ACarmina Mayela Cardenas, CPC-ACarol Carlson, CPC-ACarol Stallings, COC-ACarolyn G Mills, CPC-ACarolyn Behrendt, CPC-ACarolyn M Jones, CPC-ACarrie Klebe, CPC-ACarrie N Noborikawa, CPC-ACarrie Niland, COC-ACarrie Tenney, CPC-ACary Liberick, CPC-ACassidy Benfield, CPC-ACatalina Antochi, CPC-A

Catherine Kissinger, CPC-ACatherine Smith, CPC-ACatherine Wang, CPC-ACathy Disinger, CPC-ACathy Siffert, CPC-ACayenne Means, CPC-ACeleste Misbah, COC-A, CPC-ACelia Resendiz, CPC-ACelia Rudek, CPC-AChandrasekar Periasamy, COC-ACharity Barnes, CPC-P-ACharlene Kenney, CPC-ACharlene Lawrence, CPC-ACharlotte Chavez, CPC-ACharlotte Wade, CPC-ACharmaine Taylor, CPC-ACharniece Carter, CPC-AChase Fortenberry, CPC-AChelsey Mendonca, CPC-AChelsie Lewis, CPC-ACheri Mohr, CPC-ACheryl Benasutti, CPC-ACheryl Hodges, CPC-ACheryl Kauffman, CPC-ACheryl Presnal, CPC-ACherylanne DeStefano, CPC-ACheynet McGuire, CPC-AChristian Nirmal Satya, COC-AChristie Hicks, CPC-AChristina Atwood, CPC-AChristina Danzuso, CPC-AChristina Ferrone, CPC-AChristina Forney, CPC-AChristina Goins, CPC-AChristina Simmonds, CPC-AChristina Snow, CPC-P-AChristina Ursone-Jones, CPC-AChristopher Castro, CPC-AChristopher Kane, CPC-ACindy Dakken, CPC-ACindy Lee Crowder, CPC-ACindy Zito, CPC-AClaire Hutchinson, CPC-AClare Willis, CPC-AClaudia Gomez, CPC-AClaudia Hadley, CPC-ACodi Sadik, CPC-AColby Boggs, CPC-AColeinette Smith, CPC-AColleen Simpson, CPC-AColleen Spatafore, CPC-AConnie Wilson, CPC-ACornelius Venhuizen, CPC-ACourtney Wretberg, CPC-ACourtney Akers, CPC-ACourtney Hancock, CPC-ACourtney Lingnofski, CPC-ACristal Romero-Zelaya, CPC-ACrystal Gist, CPC-ACrystal Laird, CPC-ACrystal Pafford, CPC-ACrystal Smith, CPC-ACynthia Bodon, CPC-ACynthia Green-Slaalien, CPC-ACynthia McMorrow-Newton, COC-ACynthia Mihalick, CPC-ACynthia P Smith, CPC-ACynthia West, CPC-ACynthia Williams, CPC-ADaisy Rani Stanislas, CPC-ADaiyelin De La Nuez, CPC-ADana Irvin, CPC-ADaniel Rice, CPC-P-ADanielle Flagg, CPC-ADanielle McDermott, CPC-ADanielle Wilkerson, CPC-ADanita Jones, CPC-ADante Wilson, CPC-A

Darci Elizabeth Baptiste, CPC-ADarla Tollison, COC-ADavid Zetterman, CPC-ADawn Aulenbacher, CPC-ADawn Berkery, COC-ADawn Reynolds, CPC-ADawn Wallace, CPC-ADebamitra Pattanaik, CPC-ADebbie Born, CPC-ADebbie Hepner, CPC-ADeborah Jordan, CPC-ADeborah Ewald, CPC-ADeborah Upington-Neiman, CPC-ADebra Ball, CPC-ADeepa Shrivastava, CPC-ADeepak Negi, CPC-ADeepan Kumar D, COC-ADeesha Burr, CPC-ADelanie Smith, CPC-ADella C Shaw, CPC-ADenea Curatolo, CPC-ADenise Lyon, CPC-ADenise Blackmon, CPC-ADenise Campbell, CPC-ADenise Wallace, CPC-ADeshaydia Pope, CPC-ADiana Gomez, CPC-ADiane Cothern, CPC-ADiane Dutton, CPC-ADiane Hammell, CPC-ADiane Mae Raymundo, CPC-ADianne Pruitt-Scott, CPC-ADianne Shantz, CPC-ADianthe Cuello, CPC-ADierdre Gay, COC-ADina Ringo, CPC-ADione Mendoza, CPC-ADivyasree S, COC-ADomayka Esteves, CPC-ADominique Honeycutt, CPC-ADonna Bates, CPC-ADonna Beers, CPC-ADonna Helmold, CPC-ADonna Hendriks, CPC-ADonna J Ackerman, CPC-ADonna McGuire, COC-ADoodipala Sudha Ramya, CPC-ADoodipala Sudha Ramya, CPC-ADoris Moreno, CPC-ADorothy Ann Thenhaus, CPC-ADunia Pena Salgado, CPC-A, CPMAEboni Ne’Cole Lundy, CPC-AEffilyne Harris, CPC-AElaine Powers, CPC-AElaini Blowers, CPC-AElan Manzler, CPC-AEleftheria Manimanaki-Kush, CPC-AEliana Clanton, CPC-AElicia Dravigne, CPC-AElizabeth Anglin, CPC-A, CPPMElizabeth Connor, CPC-AElizabeth Dirling, CPC-AElizabeth Groeber, COC-A, CPC-AElizabeth Lundstrom - Smith, CPC-AElizabeth Munoz, CPC-AEmberly Kouanvih, CPC-AEmily Dose, CPC-AErica Deerinwater, CPC-AErica Saathoff, CPC-A, CHONCErika Baker, CPC-AErika Utsler, CPC-AErin Edmonson, CPC-AErin Roddy, CPC-AErin Zimmerman, CPC-AEtum Lee, CPC-AEvan Bridges, CPC-AEvelyn Brown, CPC-AEvelyn Quezada, CPC-A


NEWLY CREDENTIALED MEMBERSEvet Mascoe, CPC-AEydie Delgado, CPC-AFalguni Patel, CPC-AFarzana Bano, COC-AFaustino Ortega, COC-AFrances Elliott, CPC-AFrancheska Diaz, CPC-AG. Suma Latha, CPC-AGabriela Gaines, CPC-AGade Anusha, CPC-AGail McGee, CPC-AGail Schultze, CPC-AGanji Varaprasad Dev, CPC-AGayle McElhanon, CPC-AGeeta Goppee, CPC-AGeetha Muthuganesan, CPC-AGeetha Ravindran, CPC-AGenessa Maltman, CPC-AGenia Ginevan, CPC-AGeorge Mendivil, CPC-AGil Inocencio Competente Jr, CPC-AGiriraj Shanmugam, CPC-AGirly Gorospe, CPC-AGirthuri Swathi, CPC-AGlen Holley, CPC-AGlenda De Groot, CPC-AGoli Satya Sekhar, CPC-AGrace Kruger Sullivan, COC-AGreta Stamper, CPC-AGuadalupe Garcia, CPC-AGuadalupe Lanuza, COC-AGwendolyn Misevch, CPC-AHannah Micheliche, CPC-AHarish Kumar B S, CPC-AHarsh Kumar, CPC-AHeather A Peil, CPC-AHeather Feiler, CPC-AHeather Hughes, CPC-AHeather Sloan, CPC-AHeidi Lennox, CPC-AHeidi Reed, CPC-AHeidi Van Nurden, CPC-AHeidi Williams, CPC-AHeidy Saavedra, CPC-AHelen Agard-Drakes, CPC-AHelen McIntosh, CPC-AHemalatha Kemmai Shivappa, CPC-AHilary Donald, CPC-AHilda Daniel, CPC-AHolly Ellison, CPC-AIcilma Cornelius, CPC-AIlma Mary Farrar, CPC-AImelda Lomibao, CPC-AIndu Vijayakumar, COC-AIrasema B Cortina, CPC-AIrene Castellano, CPC-AItharaju Gayathri, CPC-AJacki Murin, CPC-AJackie Boyer, CPC-AJacklyn Peterman, CPC-AJaclyn Polenz, CPC-AJacob Hadel, CPC-AJacqueline Gail Mathis, CPC-AJacquette M Gifford, CPC-AJaeda Ertelt, CPC-AJakie Lacey, CPC-AJames Oaks, CPC-AJames Salisbury, CPC-AJames Williamson, CPC-AJamie Loggains, CPC-AJamie Weirich, CPC-AJamilyn Cervantes, CPC-AJamsheer Babu, COC-AJancy Pandian, CPC-AJane LaChance, CPC-AJanele Bunderson, CPC-AJanell Shaner, CPC-AJanet Davis, CPC-A

Janet Fernandez, CPC-AJanice E Febres, CPC-AJanielle Hayslip, CPC-AJasmin Hassan, CPC-AJavier Leon Mendez, CPC-AJay Monson, CPC-AJayne Mischke, CPC-AJayne Wyckoff, CPC-AJayvee Dilag Villanueva, CPC-AJeanette Morgan, CPC-AJeanne Anne Mauck, CPC-AJeannette Buenconsejo Eason, COC-AJeedipally Surendar Reddy, CPC-AJeethuri Shanta Kumar, CPC-AJelvin Talucod Cruz, CPC-AJenica Lundgren, CPC-AJenna Jepson, CPC-AJenna Ross, CPC-AJenna Studenski, CPC-AJennie Lee, CPC-AJennifer Pushart, CPC-A, COBGCJennifer Bott, CPC-AJennifer Contreras, CPC-AJennifer Ervin, CPC-AJennifer Ewald, CPC-AJennifer George, CPC-AJennifer Getchell, CPC-AJennifer Hamberg, CPC-AJennifer Hsu, CPC-AJennifer Hudson, CPC-AJennifer Lemme, CPC-AJennifer Looney, CPC-AJennifer Lynn Holderbaum, CPC-AJennifer Lynn Mcnear, CPC-AJennifer Montana, COC-AJennifer Pedraza, CPC-AJennifer Peters, CPC-AJennifer Shields, COC-AJennifer Urbano, CPC-AJennifer Valenta, CPC-AJenny Phillips, CPC-AJeremy Padgett, CPC-AJermaine Michelle Gonzales, CPC-AJess Bryant, CPC-AJessica Beatty, CPC-AJessica Birmingham, CPC-AJessica Justice, CPC-AJessica K Burris, CPC-AJessica Knight, CPC-AJessica Lee, CPC-AJessica Lopez, CPC-AJessica Marciniak, CPC-AJessica Marie Canales, CPC-AJessica Sharp, CPC-AJessica Sutherland, CPC-AJessica Swart, CPC-AJessica Watson, CPC-AJewely Roberts, CPC-AJeya Preeta, CPC-AJihjane Li, CPC-AJill Flowers, CPC-AJill Joest, CPC-AJill Yehl, CPC-AJillian Blythe Breidenstein, CPC-AJillian Cruz, COC-AJimmiea Lacey Stewart, CPC-AJoan Anastacia Mejia, CPC-AJoan Breese, CPC-AJoanna Rooth, CPC-AJoanne L Salvagno, CPC-AJoanne Obrien, CPC-AJoelymer Bernal Madrid, CPC-AJohn Nastro, CPC-AJohn T Mayer, CPC-AJohnna Porter, CPC-AJolanta Warzecha, COC-A, CPC-AJonathan Fiel, CPC-AJordyn Gomez, CPC-A

Jorja Rhoda, CPC-AJose Albert Inciong Protacio, CPC-AJose Verson, CPC-AJosel Tolosa Rebancos, CPC-AJoseph A Petri, CPC-AJoseph Giries, CPC-AJosey Suiter, CPC-AJoshua Bergren, CPC-AJoy Dutcher, CPC-AJoy Harmon, CPC-AJoy Lowe, CPC-A, CPMAJoyce Fischer, CPC-AJudith Harris, CPC-AJudy Duke, CPC-AJulia Hood, CPC-AJulia L Cook, CPC-AJulia R Wiley, CPC-AJulie Embry, CPC-AJulie Lynn Semmier, CPC-AJulie Velasquez, CPC-AJustin Bates, CPC-AJyothsna Pais, CPC-AK. Surender Reddy, CPC-AK.V. Rama Krishna, CPC-AKailee Henson, CPC-AKaitlyn Lagunovich, CPC-AKammy Hall, CPC-AKara Brooks, CPC-AKara VonBehren, CPC-AKaren Austria Jagmis Balasan, CPC-AKaren Babb, CPC-AKaren Bott, CPC-AKaren Dengate, COC-AKaren Fiddy, CPC-P-AKaren Kline, CPC-AKaren M Lewis, COC-A, CPC-AKaren Peterson, CPC-AKaren Redeker, CPC-AKarey Buechele, CPC-AKarin Jones, CPC-AKarthiga Kamalakannan, CPC-AKasian Holmes, CPC-AKassondra Corn, CPC-AKatelen Wheat, COC-AKatherine Burke, CPC-AKatherine Mae Warzala, CPC-AKatherine Mao, CPC-AKathleen Schwarz, CPC-AKathryn Maillard, CPC-AKathy Douglas, CPC-AKathy M Anderson, CPC-AKatie Harrison, CPC-AKatie Riedel, CPC-AKatie Vandergriff, CPC-AKatrina Jacobs, CPC-AKatrina Ramirez, CPC-AKayla Holland, CPC-AKayla Seibert, CPC-AKaylan Boldus, CPC-AKayli Braun, CPC-AKecia Lynne Johnson, CPC-AKelby Steele, CPC-AKelley Davis, CPC-AKelli Malki, CPC-AKelly Foy, CPC-AKelly Howell, CPC-AKelly Keeven, CPC-AKelly Marie Mcpherson, CPC-AKelly McKeon, CPC-AKelly McMahon, CPC-AKelly Parker, CPC-AKelly Sinno, CPC-AKendra Leatherman, CPC-AKenneth Mcintosh, CPC-AKenya Tanish DuBose, CPC-AKera Stelly, CPC-AKerry Allen, COC-AKerry Jones, CPC-A

Ketly Lafontant, CPC-AKhristine Estalilla, CPC-AKieley Downing, CPC-AKim Alleyne, CPC-AKim Cowdrey, CPC-AKim Grochmal, CPC-AKim King, CPC-AKim M Gregor, CPC-AKim Stevens, CPC-AKimberly Bennett, CPC-AKimberly Bugg, CPC-AKimberly Croy, CPC-AKimberly Deel, CPC-AKimberly Toth, CPC-AKimberly Wallace, CPC-AKimberly Wright, CPC-AKimberly Wright-Rybak, CPC-AKindra Heldreth, CPC-AKindra Wayrynen, CPC-AKiruthika Chinnasamy, CPC-AKodiarasu Elumalai, CPC-AKokila G, CPC-AKottakota Vijaya Laxmi, CPC-AKris Etter, CPC-AKrishna Chaitanya Bangaru, CPC-AKristen Barchuk, CPC-AKristen Dehn, CPC-AKristen M Bradner, CPC-AKristin Bertlin, CPC-AKristin Carlisle, CPC-AKristina Croes, CPC-AKristina Sharp, CPC-AKristina Sortland, CPC-AKristina Williams, CPC-AKrupali Desai, CPC-AKurt DeGroot, CPC-AKurt Everen Rodil Laranjo, CPC-AKwameka Dunkley, CPC-AKym L. Vu, CPC-ALacrista Cockrill, CPC-ALaDonna Clement, CPC-ALakeisha Glenn, CPC-ALalitha N, COC-ALata Ramesh, COC-ALatarsha Slappy, CPC-ALatasha Minton, CPC-ALatonya Blizzard, CPC-ALatoya Mcgaha, CPC-ALaura Castaneda, CPC-ALaura Hawkins, CPC-ALaura Jean Taylor, CPC-ALaura L Walters, CPC-ALaura Lang Coogle, CPC-ALaura Redmond, CPC-ALaura Yopp, CPC-ALauren Green, CPC-ALauren Moon, CPC-ALaurie Dittenhafer, CPC-ALaurie Giusti, CPC-ALaurie Petter, CPC-ALaurie Ward, COC-ALavanya Mamidi, CPC-ALaVelle Austin, CPC-ALavonne B Murtha, CPC-ALawrence Tuparan Leonardo, CPC-ALe Kearney, CPC-ALea Gleason, CPC-ALeah Florez, CPC-ALeanna Scotten, CPC-ALee Ann Cooper, CPC-ALee Macklin, COC-ALeena Sunilkumar, CPC-ALeisa Wordlow, CPC-ALeon Thankachan, CPC-ALesley Robinson, CPC-ALesli Gibbons, CPC-ALeslie Sanchez, COC-ALevilaida Joy Torio Azas, CPC-A

Lewanna Hedgspeth, COC-ALezlie A Atwood, CPC-ALidiya Kolomeyevskaya, CPC-ALinda Silkes, CPC-ALindsey Yates, CPC-ALisa Gilland, CPC-ALisa Belton, CPC-ALisa Cabrera, CPC-ALisa Freeman, CPC-ALisa Keip, CPC-ALisa Keneston, CPC-ALisa Michelle Deshaies, CPC-ALisa Torline, CPC-ALisa Watkins, CPC-ALissa Seesholtz, CPC-ALoretta Johnson, CPC-ALori Agid, CPC-ALori Allison, CPC-ALori Carter, CPC-ALori Cook, CPC-A, CPBLori Gannon, CPC-ALori Ross, CPC-ALori Webster, CPC-ALorraine Kambourian, CPC-ALouise Yoder, COC-ALucas M Bieneman, CPC-ALucina Gort, CPC-A, CHONCLuis Godoy, CPC-ALynda Aparicio, COC-ALyndsy McIntosh, CPC-ALynette Zartman, CPC-ALynn M Crowell, CPC-ALynn Sweetland, CPC-ALynne Schmidt, COC-AM. Harshini, CPC-AMackenzie Alyce Stanford, CPC-AMadhur Kumar Sharma, CPC-AMadhusudan Lankappa, COC-AMaggie Hafner, CPC-AMahesh Singh, CPC-AMaheswari Sivaraj, COC-AMalar Velu, CPC-AMalea Mullins, CPC-AMalika Akula, CPC-AMalissa McIntyre, CPC-AMallikarjuna Vidagotti, CPC-AManigandan G, COC-AManish Kumar, COC-AManoj Giri, CPC-AManuela Salvatore, CPC-AMarc Tuyorada, CPC-AMarcia Baker, CPC-AMarcia Boyett, CPC-AMarcille Guza, CPC-AMareeswari Ganesamoorthi, COC-AMargaret B Heins, COC-AMargaret Berube, CPC-AMargaret Kyber, CPC-AMaria Aviles, CPC-AMaria Cubi, CPC-AMaria Elena Blando, CPC-AMaria Garcia, CPC-AMaria Thompson, CPC-AMarianne Nel, CPC-AMarie Elkin, CPC-AMarie Vazquez, CPC-AMariel Ruiz Baliwas, CPC-AMarieRosiline MarieDevadass, CPC-AMarisel Mendez-Hernandez, CPC-AMarisol Torres, CPC-AMarjorie Flores Canlapan, CPC-AMartha A Phillips, CPC-AMarvin Magazine, CPC-AMary Bonine, CPC-AMary Bruening, CPC-AMary Demarest, CPC-AMary Hebert, CPC-AMary Tucker, CPC-A


NEWLY CREDENTIALED MEMBERSMatthew Bronson, CPC-AMattie Dipietro, CPC-AMaura Sheppard, CPC-AMaurice Jackson, CPC-AMedikonda Anuradha, CPC-AMegan Allen, COC-A, CPC-A, CPC-P-AMegan Bell, CPC-AMeghan Zambanini, CPC-AMelanie Kohler, CPC-AMelanie Lutes, CPC-AMelanie Pearce, COC-A, CIRCCMelinda Neeson, CPC-AMelisa Rosa, CPC-AMelissa Cyganowski, CPC-AMelissa Guenther, CPC-AMelissa Harney, CPC-AMelissa Johnston, CPC-AMelissa Peters, CPC-AMelissa Reep, CPC-AMelissa Tjon, COC-AMelissa Wirgau, CPC-AMelissa Wojdak, CPC-AMelody Nuttall, CPC-AMeredith Rooker, CPC-AMerideth Levin, CPC-AMerivim McCurdy, CPC-AMica May Angeles Colipano, CPC-AMichael Go, CPC-AMichele Beason, CPC-AMichele Fulton, CPC-AMichele Grannis, CPC-AMichelle Bell-O’Brien, CPC-AMichelle Breeding, CPC-AMichelle Fernandez, CPC-AMichelle Lynn Bouschor, CPC-AMichelle M McKeever, CPC-AMichelle Martinez, CPC-AMichelle Nguyen, CPC-AMichelle Pentecost, CPC-AMichelle Petersen, CPC-AMichelle Proffitt, CPC-AMichelle Ratterman, CPC-AMichelle Ringler, CPC-AMichelle Spoden, CPC-AMichelle Stearnes, CPC-AMichelle Swing, CPC-AMillie Illin, CPC-AMindy Deinhardt, CPC-AMindy Murdock, CPC-AMinerva Ayala, CPC-AMiranda Stanford, CPC-AMirian Rodriguez, CPC-AMirka Rivera, CPC-AMisti Darden, CPC-AMisty Fopiano, CPC-AMitchell Bantolino, CPC-AMitzi Hardimon, COC-AMohammad Zahid, COC-AMohit Sharma, CPC-AMolly Rapuano, CPC-AMolly Weinstein, CPC-AMona Preston, CPC-AMonica E Wilcox, CPC-AMonica Baland, CPC-AMonica Kidd, CPC-AMonica Ruth Ortega, CPC-AMonica Turner, CPC-AMonique Terrazas, CPC-AMorgan Rhodes, COC-AMorgan Rose, CPC-AMorgan Wayne, CPC-AMotise Junes, CPC-AMuddukrishna S, CPC-AMuffin Shearon-Nelson, CPC-P-AMurali Krishna Kolluri, COC-AMuskam Rajesh, CPC-AMyrna Lopez, CPC-ANadege Adam, CPC-A

Naga Deepthi Bolla, CPC-ANajla Yahiya, CPC-ANancy Lyon, CPC-ANancy Rodriguez, CPC-ANarmada Kumar, CPC-ANasir Mire, COC-A, CPMANeela Srinivas, CPC-ANeera Vashisht, CPC-ANgoc N Tran, CPC-ANicki Mills, CPC-ANicole Bain, CPC-ANicole Deanne Hutchinson, CPC-ANicole Florio, CPC-ANicole Roach, COC-ANicole Sue McAlevey, CPC-ANikita Saini, CPC-ANusum Kavya, CPC-ANycole Escalon, COC-AOlga Adygaeva, CPC-AOlga Martinez, CPC-AOlga Pavon, CPC-A, CPMAOlha Labert, CPC-AOlivia Barber, CPC-AP. Sowmya Sree, CPC-APalnati Balasekhar, CPC-APam Kendall, CPC-APamela Casey, CPC-APamela Custodio, CPC-APamela Kot, CPC-APamela Walker, CPC-AParthiban Srinivasan, CPC-APatrice Vary, COC-A, CPC-APatricia Belger, COC-APatricia Gourley, CPC-APatricia Greco, CPC-APatricia Guarino, CPC-APatricia I Bader, MD, MS, CPC-APatricia Risner, CPC-APatricia Truitt, CPC-APatty Glacken, CPC-APatty Troyer, CPC-APaul Teunissen, CPC-APaula Siltala, CPC-APearl Bowden, CPC-APeggy Armstrong, CPC-APeggy Breault, CPC-APeggy Goebel, CPC-APeggy Summersill, CPC-APenugonda Prabhakar Reddy, CPC-APeter Braaksma, CPC-APhani Sekhar Padala, CPC-APhillippa Cooper, CPC-APhyllis Ferreira, CPC-APhyllis Pierce, CPC-APoongodi Ramu Elango, CPC-APrabha Kesavan, CPC-APrakash S, COC-APrasanth Sundar, COC-APratheeksha Velloden, CPC-APraveena Velpula, CPC-APraveenKumar Mulagada, COC-APrince Pullan Jacob, CPC-APrincess Short, CPC-APriscilla Agirre, CPC-APriya Gokularamana, CPC-APriyanka Babu, CPC-APuttiphon Triyasakorn, CPC-AR. Rajitha, CPC-ARachael Belunza, CPC-ARachel Brown, CPC-ARachel Reid, CPC-ARachel Tejeda-Sotelo, CPC-ARachelle Mueller, CPC-ARahul Pandey, COC-ARajappa H P, COC-ARajender Kumar, CPC-ARajesh Chikoti, CPC-ARajkumar Karuppiah, CPC-A

Rajni Dogra, CPC-ARamya Kannanoor Jayaveer, CPC-ARamya Mani, COC-ARanae DAlessio, CPC-ARandy Gardner, CPC-ARani L.R., CPC-ARaquel H Garcia, CPC-A, CEMCRavi Kumar P, CPC-ARebecca Shultz, CPC-ARebekah Oh, CPC-ARebekah Soikkeli, CPC-ARegina Sherrell, CPC-ARenata Hurn, COC-ARenee Parks, CPC-ARenuka Upputuri, CPC-ARhonda Nicole Ceballos, CPC-ARia Khan, CPC-A, CRCRichard J Resendes Jr, CPC-ARiman Chanda, CPC-ARinitha Raj, CPC-ARio Mendoza Baltazar, CPC-ARita Brewer, CPC-ARobert Cullen, CPC-ARobert Dorshimer, CPC-ARobert Schaaf, CPC-ARobin Bradley, CPC-ARobin Garduno, CPC-ARobin Hawkins, CPC-ARobin L Kessinger, CPC-ARobin R Coffey, CPC-ARochelle Partridge, CPC-ARoderick Herring, CPC-ARoja Rani Medarametla, CPC-ARomero Royster, CPC-ARonald Frazier, CPC-ARonald Magno Valdez, CPC-ARosaChristine Marshall, CPC-ARosalind Sanders, CPC-ARoshundal Collins, CPC-A, CPMARoxana Colmilio, CPC-A, CPMARoxanne Barcroft, CPC-ARuby Ann Vitasa Santos, CPC-ARukhsar Khan, CPC-ARuth vijaya Priyanka, COC-AS N V C Anjaneya Swamy Namburu, CPC-AS. Nainthara, CPC-AS. Satish Kumar, CPC-ASabrina Fox, CPC-ASabrina M Garcia, CPC-ASagitha Kaiparmbil Johny, CPC-ASainath Pavankumar, CPC-ASajeer O, CPC-ASalina Christian, CPC-ASamantha Finn, CPC-ASamantha Koogler, CPC-ASamantha Miller, CPC-ASamantha Ramprashad, CPC-ASamantha Thibodeau, CPC-ASamara Lynn, CPC-ASamia Majid, CPC-ASamina Habibi, CPC-ASandeep Aravindakshan, CPC-ASandeep Masabathini, CPC-ASandra Krishka, CPC-ASandra Lee Clause, CPC-ASandra Pellechio, CPC-ASandra Picon, CPC-ASandy Noel, CPC-ASanil S, COC-ASanjo T Jose, CPC-ASara Spanovich, CPC-ASara Landwehr, CPC-ASarah Kos, CPC-ASarah Schubert, COC-A, CPC-ASarah Sims, CPC-ASarah Urban, CPC-ASarah Watkins, CPC-ASaranya V, CPC-A

Sarithap Polepelli, CPC-ASasidhar Makka, COC-ASasirekha S, CPC-ASasmita Bal, CPC-ASatnam Singh Sehmbi, CPC-ASatyanarayana Reddy Ileni, CPC-AShaina De Moraes, CPC-AShamika Anthony, CPC-AShanee Jones, CPC-AShannon Gibson, COC-AShannon Middleton, CPC-ASharnetta Dennis, CPC-ASharon Clara Fernandes, CPC-ASharon Kaye Malone, CPC-ASharon Murphy-Dowd, CPC-AShary J Campo, CPC-AShatharashi Naresh Kumar, CPC-AShawn Willingham, CPC-AShawnia Grohs, CPC-ASheila Gilmer, CPC-AShelby Dewey, CPC-AShellie Dawn Parker, CPC-AShellie Thompson, CPC-ASheri Ann Kaminski, CPC-ASherindas Anaswara Gopidas, CPC-ASherri Barnett, CPC-ASherry Denning, CPC-ASherry Markey, CPC-ASheryl Nevalainen, CPC-ASheryll Mavrov, CPC-AShimy James, CPC-AShiny Thomas, CPC-AShobana Rangan, CPC-AShondra Jones, CPC-AShreena Bindra, CPC-ASidney Garcia, CPC-ASinoun Parina, CPC-ASirimalla Yeshwanth, CPC-ASobhan babu Kasarla, COC-ASoma Poddar, COC-ASomen Podder, COC-ASonja Jolly, CPC-ASoumya Sajeev, CPC-ASreehari Modela, CPC-ASripriya Prasad, CPC-AStacey Bridenback, COC-A, CPC-AStacey Smith, CPC-AStacy Cannariato, CPC-AStacy Lutz, CPC-AStanley Davis White, CPC-AStephanie Gay, CPC-AStephanie Hardcastle, CPC-AStephanie M. Williams, CPC-AStephanie Rockwell, CPC-AStephanie Torres, CPC-AStephanie Woollard, CPC-AStephany Marshall, CPC-ASumerta Ochani, COC-A, CPC-ASunil Krishna Kolluru, CPC-ASurbhi Sharma, CPC-ASuresh Javvaji, CPC-ASusan Hrvatin, CPC-ASusan Misemer, COC-ASusan Halsne, CPC-ASusan Hawkins, CPC-A, CPBSusan Herring, CPC-ASusan Kuhn, CPC-ASusan Lynch, CPC-ASusan McGurran, CPC-ASusan Niles, CPC-ASusan Perez, CPC-ASusan Powell MD, MPH, CPC-ASusan Sayers, CPC-ASusan Vincent, CPC-ASuseela Seetharaman, CPC-ASusheela Singh, CPC-ASuvada Ibrahimovic, CPC-ASuvalam Nagma, COC-A

Suzanne Sherling, CPC-ASvetlana Woersching, CPC-ASwastik Das, COC-ASybille Schnappup, CPC-AT Vikram Singh, CPC-ATamara Mitchell, CPC-ATammi Poling, CPC-ATammy Carter, CPC-ATammy Crenshaw, CPC-ATammy Ploegman, CPC-ATanna Niemeier, CPC-ATanya Killian, CPC-ATanya Pindell, CPC-ATappala Satish, CPC-ATara Rivenburg, CPC-ATawonna Ingram, CPC-ATeresa Kay Hubbard, CPC-ATeresa Kennington, CPC-ATeressa Ingram, CPC-ATeri Dill, CPC-ATerrance Myers, CPC-ATerri Elkins, CPC-ATerri Silva, CPC-P-ATharshana Maheswaran, CPC-AThasneem Nishad, CPC-ATheresa Blundell, COC-ATheresa Chippie, CPC-ATheresa Williams, CPC-AThiruvenkitan Padmanandini, CPC-AThomas Horodecki, CPC-AThreveen Challa, COC-AThu Quynh Tran, CPC-AThushara Sivaprasad, CPC-AThuy Minh Than, CPC-ATiffany Nutter, CPC-ATiffany Rivero, CPC-ATiffini Daubert, CPC-ATimothy Phillips, CPC-ATimothy Shipp, CPC-ATin Win-Qiu, CPC-ATina Finnerty, COC-ATina Flannery, CPC-ATina L Covington, CPC-ATina McNeill, CPC-ATina Vickers, CPC-ATodd Wagner, CPC-ATongela Gamble-Blount, CPC-AToni Sorey, CPC-ATony Pookekudiyil, CPC-ATonya Shamone Miller, CPC-ATori Howard, CPC-ATori Nicole Ulm, CPC-ATracey Kistner, CPC-ATraci Brun, CPC-ATracy Cross, CPC-ATracy Lynn Coccia, CPC-ATracy Sellers, CPC-ATracy Spencer, CPC-ATracy St. Amand, CPC-ATrisha Mae Riosa, CPC-ATristin Klumb, CPC-ATwyla Taylor, CPC-AUjjal Ganguly, CPC-AUma Keshavamurthy, CPC-AUpasu Chatterjee, CPC-AValerie Hills, CPC-AValerie Waites, CPC-AVanessa D Bautista, CPC-AVanessa Foley, CPC-AVanessa Perez, CPC-AVeena Selvaraj, CPC-AVenkateshvaran Pachamuthu, CPC-AVera Beckham, CPC-AVeronica Guzman, CPC-AVeronica Vega, CPC-AVicki Weisenberger, CPC-AVickie Lynn Ford, CPC-AVicky Vick, CPC-A


NEWLY CREDENTIALED MEMBERSVictoria Byers, CPC-AVictoria Germann, CPC-AVidya Praveen M, CPC-AVijay Kumar H N, CPC-AVilayphan Hoffman, CPC-AVinoth Kumar, COC-AVinu Ravindran, CPC-AVishal Bhardwaj, CPC-AWalkiria Batista, CPC-AWalter Ferencic, CPC-AWalter Ferencic, CPC-AWanda Pavlat, CPC-AWendy Gonsioroski, CPC-AWendy Kuenning, CPC-AWendy Olson, COC-A, CPC-A, CHONCWendy Pearson, CPC-AWesley Naval, COC-AWhitnee Holloway, CPC-AWhitney Boudman, CPC-AWhitney Bruner, CPC-AXenija Cortez, CPC-AY. Sabala, CPC-AYanamala Vijaya Lakshmi, CPC-AYensembam Premlata Devi, CPC-AYolanda Balossi, CPC-AYolanda Gastelum, CPC-AYusmila Gonzalez, CPC-AZendra Weller, CPC-A

SpecialtiesSpecialtiesSpecialtiesAddiss Maldonado Mendez MD, CPC,

CPMA, CEDC, CRCAdelina Ng Ewing, CGSCAdilah Rashid, CPC, CPMAAdrianne Eguaras Gonzaga, CPC, CRCAgnes A Osuji, CPC-A, CRCAida Proenza, CPC, CPC-P, CPMA, CPC-I,

CRCAlena Du, CRCAlexandra Taylor, CPPMAlfredo Sanedrin, CICAlice Christine Hrubec, CICAlison Hildreth Coleman, CPC, CPCO,

CEMCAlka Singh, COC, CEDCAllison Tilley, CPC-A, CRCAlma Delia Zarate, CPC-A, CPMA, CENTCAlyssa Stites, CPC, CEMCAmaechi Lawrence Ofunne, CPC, CPMA,

CEMC, CGSC, CPRCAmanda Brodsky, CPC, COSCAmanda Dorozsmay, CPC, CRCAmanda Sainsbury, CPC-A, CPMAAmber Harris, CPC, CRCAmber M Theodore, CPC, CIMCAmi Martinez, CICAmruta Paranjape, CPC, CPMA, CEMC,

CENTCAmy Layton, CPC, CPMAAmy Nichole Chapman, CPC, CPMA, CICAmy Sandoval, CPC, CRCAmy Vaughan Oehler, CPC, CEMC, CFPCAna M Lopez, CPC-A, CPMAAnabel Silos, CPC, CEMCAnayas Zinzuvadia, CPCOAndre Carlos Smith, CPB, CRHCAndrea Baskette, CPC, CPMA, CEMCAndrea Marmolejos, CPMAAneta Lukasiewicz, COC, CPC, CPBAngela Kristen Sanders, CPC, CPBAngela Lee Morales, CPC, CRCAngela M Hayes, CPC, CPB, COSCAngela Yauman, CPBAngelique Kaplan, CASCCAngie Wilson, B.A., CPC, CPB, CRC

Anissa Lynn Foley, CPC, CEMCAnjanette Rena Gilchrist, CPC, CPMAAnn Bush, CPC-A, CEDCAnn Fullerton, CPC, CRCAnn Klatt, CPC, CPMAAnna M Parrow, CPC, CPMAAnna Marie T Mottice, CPC, CRCAnna-Marie Sorrento, CPBAnne Nuckols, CPBAnnmarie Janz, CPC, CRCAnthony Carr, CPPMAnuradha Rao, CPC, CRCAracelli Francisco, CICArlene Garza, CPC, CRCAryn Harding, CPBAshley F Reitz, COC, CPC, CPMAAshley Hack, CPC, CPMA, CPPMAudrey Carter, CPC, CRCAudrey Coaxum, CPC, CEMCAudrey de Guzman, CPBAudrey Olson, CRCAudrey Wright, CPC, COSCAvicia Gail Moss, CPC, CPMA, COBGCBarbara McKenna, CPC, CRCBarbara L Knox, COC, CPC, CPC-P,

CPMA, CPPM, CEMCBarbara Regalado, COC, CPC, CPMABecky J Belcher, CPC, CEMCBekah Kutt, CPC, CPCOBelgica Moreno, CPC-A, CPMA, CRCBelinda Kramer, CPC, CPMABelinda Londenberg Webb, CPC-A, CPBBelinda Ratcliffe, CRCBeth Riddell, CPMABetty J Ostrander, CPC, CFPCBetty Williams, COC, CPMA, CRCBeverly Ann Lewis, CPC, CPMA, CEMC,

CGSC, COBGCBeverly Welshans, COC, CPC, CPMA,

CPC-IBibi Khan, CPBBiennice Gomez, CICBinaya Aryal, CRCBrandy Lampert, CPBBreanna Williams, CPC-A, CRCBrenda Leto, CPBBrenda Mott Griggs, COC, CPC, CPC-P,

CPMABrianne L Garnett, CPC, CPMA, CEMC,

CGSC, COSCBrittany Adams, CPC-A, CRCBrittany Bash, CPC, CCCBrittany Cheeseman, CPC, CPBBrittany Marques, CRCBrittany Wheatley, CPC, CRCCalisa Johnson, CPC, CPMACarina Conti, CPC, CPMACarla Francesca Acevedo, CPC, CENTCCarla J Weaver, CPC, CEMC, COSCCarla Tierney, CPC, CPC-P, CPMACarmen Crawford, CICCarolyn Elrod Rucker, CPC, CASCCCarolyn S White, CPC, CPMA, CCC,

CGSC, COSC, CRC, CUCCarrie Holstrom, CPB, CGICCarrie R Baughman, CPC, CFPCCasey Hickman, CPC, CICCatherine Jones, CPCOCecilia Phillips, COC, CRCCharmylen Wong, CICChelsea Kemp, COC, CEDCCheryl DeMarree, CRCCheryl Hunt, CPC, CGICCheryl L Radcliffe, CPC, CRCCheryl L. Theriault, CPC, CPBChing Yee Millor Tsui, CPC, CANPC, CRCChristin Brodrick, CPC, CICChristina Bright, CRC

Christina E Ericson, CRCChristina Llampay-Medina, CPC, CPB,

CPMA, CPPMChristina Miranda, CPC, CPBChristine C Schmotzer, COC, CPC, CPMA,

CEMC, CRCChristine Newell, CPC, CPBChristine Robin Downing, CPC, CRCChristine Roketa Johnson, CPC, CRCChristine Smith, CPC, COBGCChristy ODell, CPC, CPMACindy A Wagner, CPBCindy Hester, CPBCindy Kamm, CPC, CRCCindy McCarter, CPC, CHONCClaire Marchand, CPBClaudine Elizabeth Sloppy, CPC-A, CPBColby Dempsey, CPBColette Bohon, CPC, CRCColleen Hill, CPC, CPMA, CPPMConstance Eckenrodt, CRCCorinne Leigh Wudarsky, CPC, CPMACortney Colbert, CPBCrystal Djordjevic, CPC, CRCCrystal Gutierrez, CPC, CPBCynthia Freese, CPC, CICCynthia Grayer, CPC, CRCCynthia Lasnier Unger, CCVTC, CGSCCynthia Lorraine Lake, CPC, CPMACynthia Weathers, CPC, CPMADaile Wells, CPC-A, CRCDana Covington, CPC, CPMA, CHONCDana Nicole Wallace CMBS, CPC, CPMADana Westerman, CPC, CPMA, CRCDanielle Maguire, CPC, CPMA, CGSCDarla Hammons, CPC, CPBDarlene Dahl, CPC, CPB, CPMADavid Chenette, CPBDavid J. Layfield, CPC, CPMADavid M Ratliff, CPC, CPMA, CRCDawn Davis, CPC, CPMADawn Kurelko, CPC, CPMADeana Tuorto, CPBDeanna Gambino, CPC, CRCDeanna Scala, CPC, CEMCDebbie Delene Deprest, CPC, CPC-P,

CPB, CPC-IDebbie K Smith, CPC, CPC-P, CPMADebbra Saunders, CRCDeborah Buck, CPC, CPB, CANPCDeborah Job, CPC, CRCDeborah Lynn Forde, CPC, CPCO, CPMADeborah Mixon, CIRCCDeborah Rhoads, CPC, CPMADeborah Stezko, CPBDeborah Zarick, CPC, CPCO, CPMA, CPC-

I, CEMC, CRCDebra Giangrande, CPC, CPBDebra Lynn Bales, CPC, CRCDebra Pennington, CPC, CEMCDebra Stephenson, CPC, CPMADebra Susan Jacobson, CPC-A, CICDebra Zechman, CRCDeirdre M Johnston, CPC, CRCDelia Dominguez, CPMA, CRCDella R Canter, CPC, CEMCDenise Bonavita, CPBDenise Johnson, CPC, CPBDenise Nelson, CPC-A, CPBDhwani Umeshbhai Patel, CRCDiana Pelham, CPC, CPMADiana L Reece, CPC, CPC-P, CRCDiana Lynn Yates, COC, CPC, CPMA,

CPC-I, CPEDCDiana Rusk, CPC, CEMCDiana Sperry, COSCDiane Paterson, CPC, CEDCDiane Walczak, CPC, CPMA, CUC

Dianne C Estes, CPC, CPBDolmaya Thogra, COC-A, CIRCCDon Marfee Koh, CICDonna Beaulieu, CPC, CPMA, CPC-I,

CEDC, CEMC, CFPC, CRCDonna Helgeson, CPC, CPMA, CEMCDonna Marie Smith, CPC, CRCDonny Flores, CPC, CPCO, CRCDulcisima G Razon, COC, CPC, CRCDunia Pena Salgado, CPC-A, CPMADustin Jameson, CPC-A, CPBDwlinda S Core, CPC, CPMA, CEMC,

CRCDytha Lynn Poole, CPC, CPMA, CANPC,

CRCEbonie Griffin, CPC, CHONCEileen Pinares, CPC, CPMA, CPC-I, CRCElaine Griffel, CPC, CRCElena Tenorio, CPBElizabeth Giustina CCS-P, CRCElizabeth McGee, CPBElizabeth Tica, CPB, CHONCElke E Cranfill, CPC, CIRCC, CPMA,

CCVTC, CEMC, COBGC, CUCEmily Chighizola, CPC, CCCEmily Cliber, CPC-A, CPBEmily White, CPBEmir Garcia, CPMAEmmanuel Sena Damalie, CPC, CPMAEnerius Ilano, CRCErica Everhart, CPC, CPEDCErika Alexandra D’Amico, CPC, CIRCCErika Lyons, CPC, CRCErika Rohde, CPC, CRCErlinda S Balaan, CPC, CPEDCEssence Williams, CPC-A, CRCEunice Meredith, CPMAFatima Shayne Pamintuan, CICFelisha Chadwell, CPC-A, COBGCFia Browne, CRCFrances Donnilyn Bianan, CICFrank Mesaros, CPC, CPCOG. Elizabeth Wilson, CPC, CPCO, CPMA,

CEMC, CRCGabrielle Gearhart, CPC-A, CEDCGail A Rodriguez, CPC, CUCGail Cajigal, CPC, CPBGina Rutigliano, CPC, CPCO, CPMA, CEMCGlenda Cole, CPC, CPMAGowthami Konakalla, CICGrace Antonio, CICGraciela Khan, CPC, CPMAH Patricia Haller, CPC, CPMA, CEDC,

CEMCHaley Dodd, CPC-A, CENTC, CRHCHannah Mina May Killinger, CPC, CRCHeather D Gatton, COC, CPC, CPC-P,

CPMA, CFPC, CIMC, CRHCHeather Davis, CRHCHeather Lynn Scudder, CPC, CRCHeather M Calhoun, CFPCHeather M Richmond-Munyon, CPC, CPMAHeather Renee Smoot, CPC, CPMAHeather Rhea Nichols, CPC, CRCHeather Roland, CPBIldiko Balogh, CPC, COSC, CSFACIrich Balatbat, CICIsabella Demedici, CPC-A, CPEDCJacki D Miller, CPC, CCCJacqueline Bolcar, CPC, CPMAJacqueline Hargrove, COC, CPC, CPMA,

CRCJacqueline Soto, CPC, CPMAJacqulyn Whittemore, CPC, CRCJamie A Wilson, CPC, CPMAJamie Fellinger, CPC, CPMA, CRCJamie Stahl, COBGCJamie Sweeney, CPC, CPMA, CPPM, CEMC

Jammie Barsamian, CPC, CPMA, CCC, CEMC

Jan Sawyer, CPCOJana Welton, CPPMJane Nielsen, CPMAJane Shafer, CPMAJanice Misla, CRCJaro Mayda, CPC-A, CPMAJarod Rybacki, CPC, CPMAJean M Smith, CPC, CPMA, CEMC, CRCJean Stockman, CPC, CRCJen Carron Bueddeman, CPC, CRCJennifer Angela Tappan, CPC, CPC-P,

CCVTCJennifer Corona, CPC, CPBJennifer Fu, CPC, CPBJennifer Hayes, CPC, CPCOJennifer Lynn Matthews, CPC, CEMCJennifer Lynn Monfils, CPC, CRCJennifer Pelletier, CPC, CICJennifer Quinn, CPC, CPMAJermeika Burks, CPC, CPMAJeronima Corea, CPC, CRCJessica Elaine Turcotte, CPC-A, CRCJessica L Bolton, CPC, CGSCJessica M Frabott, CPC, CPMA, CEDCJessica Searnock, CPC-A, CPMAJessica Short, CPC, CPMA, CIMC, COSCJillian Long, CPC, CRCJne’ Munoz, CPBJo Ann Richards, CPBJoan Snodgrass, CPC, CPBJoanne DeWitt, CPC, CRCJoanne E Moser, CPC, CRCJodi Houston, CPC, CPMA, CRCJohn Piaskowski, CPMAJosie Ovella Gonzalez, CPC, CPMAJovena Kuen Cheung, CPC, CRCJoy Arient, CPBJoy Ridlehuber, CPC, CRCJoyce Sulinski, CRCJuan Miguel Alonso, CPC, CPMA, CRCJudith Wiegand, CPC, CGIC, CPCDJudy K Perkins, CPC, CPCDJudy L Smith, CPC, CPB, CPMA, CPC-I,

CEDCJudy Mayor-Davies, CPB, CFPCJudy Navarro, COC, CPC, CEDCJulia Ann Musekamp, COC, CPC, CPB, CICJulia Nabiullina, CPC, CPCO, CPMAJulia Santiago, CPC, CPMA, CRCJulie A Davis, COC, CPC, CPCO, CPMA,

CPC-I, CRCJulie A Linn, CPC, CRCJulie Cremeans, CPBJulie Serafin, CRCJulieta Londono, CPC, CPMAJyoti Shah, COC, CPC, CRCKaitlyn McCoid, CPC, CPMAKaleta Ryan, CRCKara Silvers, CPC, CPB, CPC-IKaren Ann Olvera, CPC, COSCKaren Betts, CPB, CPPMKaren Keating, CPMAKaren Lemermeier, CPBKaren Magda, CPC, CHONCKaren Murphy, CPBKaren Salter, CPBKaren Torres, CPC, CRCKarlene Dittrich, CPMAKarrie May, CPC, CPMAKatherine G. Barnes Sa, CPC, CRCKathleen Ann Mulligan, CPC, CRCKathrn Lauf, CPC, CEMCKathryn Jewell Robinson, CPC, CPRCKathryn Williamson, CPC, CICKathy Denise Bufford, CPC, CRCKathy Lynn Daniel, CPC, CPMA, COSC


NEWLY CREDENTIALED MEMBERSKatie Hagan, CPC, CPMA, COBGCKatie Niehoff, CPBKayla Biag, CICKelly Johnson, CPC, CPC-P, CENTC, CFPCKelvin Smith, CRCKendra Clure, CRCKendra Mcbride, CPC-A, CASCCKenia Valle Boza, CPC, CPMA, CRCKenrick Mui, COC, CPC, CPMA, CUCKent R Smith, CPC, CPMA, CRCKent R Smith, CPC, CPMA, CRCKerri Fleming, CPBKerry Shapkin, CRCKevin Michael Castro, CICKhushwinder Singh, CPC, CRCKim Jenisch, CPC, CPMAKim Paula Dionisio, CICKimberly A Brooks, CPC, CPBKimberly Ann Hyatt, CPC, CCCKimberly Bochtler, CPC-A, CRCKimberly Brown, CPB, CPPMKimberly R Davis, CPC, CPMAKimberly Reid, CRCKimberly Sawyer-McWright, RHIT, CPC,

CPMAKimberly Stillings, CPMAKina Carlisle-Gentles, CPC, CEMCKishore Masilamani, CPC, CCC, CCVTCKlarissa Kuhn, CPC, CPC-P, CRCKondalrao Masarapu, CICKrista Getgen, CPC-A, CPEDCKrista K Anderson, COC, CPMAKristen Hurst, CPC, CPMA, CEMC,

CGSC, COSCKristen Sullivan, CPC, CEMCKristin Elizabeth Johnson, CPC, CRCKristina Lange, CPC, CEDCKristine Camille Tanedo, CICLacey Jennings, CPC, CPBLana Miller, CPC, CPMA, CPCDLarry Roberson, CPC, CPMA, CRCLashawn Hall, CPC, CRCLaShonda H Wilson, COC, CPC, CRCLateefah Robinson, CPC, CRCLaTosha Bridgewater, CPC, CPRCLaura G Bertke, CPC, CPMA, CEMCLaura New, CPC, CHONCLaura W Kersey, CPC, COBGCLauran Diane Kunze, CPC, CRCLaure A Lopez, CPC, CFPCLaurel Savage, COC, CPC, CPMALauren A Erger, CPC, CRCLauren Anne Peterson, CPC, CPMA, CRCLauren G Marscher, CPC, CRCLauri Palmer, CPC, CPMALaurie Boutte, CPC, CRCLaurie C Udarbe, CPC, CPMA, CRCLaurie Wright, CPBLeah Rachel Christy, CPC, CPCO, CPMA,

COSCLeanne M Miles, CPC, CPCOLee Ann Seyller, COC, CPMA, CEDC, CRCLeesa J Glassick, CPC, CRCLeo G Cifers, CPC, CIRCCLesley Susan Wagner, CPC, CPB, CPC-ILeslie Palmer, CPC, CANPCLeslie Cabrera, CPC, CPMALeslie Slater, CICLetha Cannedy, CPC, COBGCLinda Denise Rhodes, CPC, CRCLinda Faye Sullivan, CPC, CANPCLinda M Felix, CPC, CRCLinda Pinchiaroli, COC, CRCLinda Rose Jones, COC, CPC, CRCLinda Smiley, CRCLindsey Strozzo, CPBLinh Ton, COC, CPC, CPC-P, CPMA, CICLisa Brooking, CPC, COBGC

Lisa Ellen Gondola, CPC, CPMA, COSCLisa Goff, CRCLisa Marie Coppens, CPC, CRCLisa Matthews, CPC, CRCLisa Morrison, CGSCLisa Poppenhouse-Davis, CPC, CPMALisa Renee Gerber, CPC, CPMA, CEMC,

CRCLisa Sedleski, CPC-A, CPMALisa Stark, CPC, CPBLisa Wright, CPCOLissania Evaro, CRCLois Smith, CPC, CRCLorene Moore, CPC, CPMA, CEMCLoretta M Jarrett-McDonald, CPC, CPMALori A Trujillo, CPC, CRCLori Ann Watkins, CPC, CEMCLori Lee Eskew, CPC, CPMA, COBGCLori Niebaum, CPC, CPMA, CEMCLori Schaffer, CPC, CEMCLorie Greenwood, CPC, CPPMLorraine Ann Hayward, CPC, CRCLorraine C McCormack, CPC, CPMALourdes Lucila Artiz, COC, CPC, CPMA,

CRCLuAnn Weis, COC, CPC, CPCO, CPMALuke Z Marsh, CPC, CRCLupe G Garza, CPC, CCCLynda Wetter, CPC, CPMA, CEMC, CGSCLynette Dunn, CRCLynn Brockman, CPC, CPBLynn Stachlowski, CPC, CPC-I, CPEDC,

CRCLynne Hedden, CICMachaelle M Diaz, CPC, CPMA, CRCMadhu Vohra, CPC, CPMA, CEMCMahammad Samir Yusufali Saiyad, CRCMahendra Ashok Jogdankar, CPC-A,

CEMCMaikel Alfonso, CPBMairu Nisha, CPC-A, CICMandy Barber, CPC-A, CRCMarco Antonio Magdangal, CICMargaret Hutton, CPC, CRCMargarita Ibarra, CPC-A, CRCMaria Gabriela Tardencilla, CPC, CPMA,

CRCMaria L Munoz, CPC, CANPCMaria Noel Gazzolo, CPC, CPB, CPMAMarie Cormack, CPC, CIMCMarie Sloan, CPBMario Fucinari D.C., CPCOMarjory Del Mando, CICMark Kozu, COC, CPC, CCCMark Schneider, CPCOMarlene Senn, CPC, CPBMarnie Fisk, CPC-A, CPBMary Christine Ladzinski, CPC, CPMA,

CCC, CGSCMary Conyne, CPC, CEMCMary Kelly, CPC, CEDCMary Peabody, CPC, CPMA, COBGCMary Wolfe, CPCOMaryenia Pena, CPC, CPMA, CRCMarylou Gaffney, CICMaura Altschuler, CPC, CRCMayra Garcia, CPC, CPBMechelle Winet, CPBMegan K Bruce, CPC, CIRCC, CCC,

CCVTCMegha Harikantra, CICMelanie Anderson, CPC, CPMA, CGSCMelanie Ward, CPC, CPBMelissa Chancellor, CICMelissa Chancellor, CICMelissa D Moore, COSCMelissa Huffman, CPC, CPBMelissa J Whitcomb, CPC, CGSC

Melissa Kristine Ohearn, CPC, CRCMelissa MacDonald, CPC-A, CPBMelissa Marie Guzman, CPC, CRCMelissa Muka, CPC, CRCMelissa Smith, CPC, CPEDCMeri Anne Wright, CPC, CPMAMerlys Gutierrez Safonts, CPC, CPB,

CFPCMichael Anthony Torres, CPC, CRCMichael Seiler, CPPMMichele Ann Zimmerman, CPC, CPMAMichele Bielski, CPC, CEMCMichele Elizabeth Chatham, CPC, CPMA,

CRCMichele Flandreau Holtzhouser, CPC,

CCC, CCVTCMichelle Delapast, CPC, CRCMichelle E McDonald, CPC, CPMA, CRCMichelle L Boucher, CPC, CPMAMichelle Leigh Dietterick, CPC-A, CRCMichelle M Coriell, CPC, CPMAMichelle McWilliams, CPC, CPMAMichelle Rene’ West, CPC, CPMA, CEMC,

CRCMichelle Sackett, CPC, CFPCMiles Artates, CICMirta Maria Mazon Gonzalez, CPC,

CPMAMisty D Engle, CPC, CPCOMisty Fuller, CPC, CPCO, CPMA, CEMCMohsin Ahamed Khan, CPC-A, CICMona Schmitt, CPC, CRCMonica Ranea Rudd, CPC, CRCMonique Akaka, CPC, CPMA, CRCMonique N Ward, CPC, CGSCMurali Kokkeragadda, CICMyra Fishback, CPC, CRCMyra O’Kelley-Johnson, CPC, CFPCNadine R Jones, CPC, CRCNancy Garcia, CPC, CPB, CPMANancy Rios-Avila, CPC, CPMA, CUCNanette Dolsen, CPC, CPC-P, CRCNaseem Babwani, CPC, CPBNatausha Pratt, CPC, CPMANathan Johnson, CPMANehreida Sifuentez, CPC, CRCNekkole Dimick, CPC, CEDCNichole Dempsey, CFPCNicole Moretto, COSCNicole Richie, CPC, CPBNicole Treber, CPC, CPBNina Phan, CIRCCNorman Lagurin, CPC, CRCNydia Lara Huggler, COC, CPC, CRCOdettys Oramas, CPC, CPMAOlga Hamel, CPC, CPMAPam Vanderbilt, CPC, CPMA, CPPM,

CPC-IPamela Ann Laroya, CICPamela Foytlin, CEMCPamela Miles, CPC, CRCPamela Terrell Roberson, COC, CPC, CRCPatricia Hardy, CCA, CRCPatricia J Johnson, CPC, CPMAPatricia James, CPC, CPMAPatricia Roucken, CPC, CRCPatricia Thames, CCVTCPatti Johns, COBGCPaul Pandi Bose, CPC, CRCPaul Wojnar, CPC, CPCOPaula A Melendez, CPC, CEDCPaula Capeto-Fischer, COC, CPC, CRCPavithra Poovizhi, CRCPenney Greene, CPC, CRCPranitha Vajinapally, CICPrasanthi Sure, CRCPraveen Reddy Kommera, CRCPreeti Bidhury, CPC, CIC

Prem Kumar Mahalingam, CPC, CRCPrince Jan Gulfwique Adube, CICQutrina N Carter, CPC, CPC-I, CEMCRachael Bender, CPC-A, CEDCRachael Prenkert, CPC, CRCRachel Nicole Hosford, CPC, CRCRamon Alerta, CICRamona Gail Mahaffey, CPC, CPMA,

CPPMRaymond Griffith, III, CPC, CRCRebecca Hernandez, CPC, CPMARebecca Lynn Johnson, CPC, CRCRebecca Poff, CPC, CPMA, CGIC,

CHONC, CPCDRenato Dungao, CRCRene A Perez, CPC, CPMA, CRCRenika Ramsey, CPC, CPMARhonda Kilmer Brito, CPC, CRCRhonda Mary Wooley, CPC, CHONCRhonda Robinson, CPC, CPMARhonda Smart-EL, CPC, CRCRobin I Sievert, CPC, CCCRobin Kovalchek, CRCRobin Watrous, CPC, CEMCRoger L Hettinger, COC, CPC, CPCO,

CPB, CPMA, CEDCRomina Brawn, CPC, CPB, CPMARyan Pagcu, CICSabinna Michelle Cavnar, CPC, CRCSamantha L Smith, CPC, CEMCSamantha Stensland Little, CPC, CPMASandra K Clendenny, CPC, CIRCCSara Aceves, COC, CPBSarah Eschette, CPC, CPPM, CEMCSarah Nelson, CPC, CRCSarah Sebikari, CPC, CPCO, CRCSarah Shervanian, COC, CPC, CPMASarah Sotherden, CPC, CPMASaul A Anaya, CIRCC, CASCCSean Corwin, CPC-A, CRCSean Pasamonte, CICShannie Moore, CPBSharon Evangeline Hunter, CPC, CGSCSharon Folker, CPC, CEDCSharon K Smith, COC, CPC, CPPMSharon Phillips, CPC, CEMC, CGSCSharon Test, COC, CPC, CPPMShavawn Perschka, CPC, CPMAShawna Brooke Wilkes, CPC, CIRCC, CPB,

CPMA, CGSCSheila Barela, CPC, CPCO, CPMASheila Norton, CPC-A, CRCShelby West, CPC, CPMAShelley J Thibedeau, CPC, CGICSheri Michaelis, CPC, CPMA, CRCSherita E Turner, CPC, CRCSherry Jimenez, CEDCSherry Lou Coggins, CPC, CRCSherry Ransom, CPC, CRCShobana Seetharaman, CPC, CPMAShu Zhen Liu, CPC, CIRCC, CCC, CCVTCSnufa Sadick, CPC-A, CPMAStacey Holmes, CPC, CPMAStacy Plaia, CPC, COSCStephanie A Rossi, CPC, CPMA, CFPCStephanie Huss, CPBStephanie Klutts, CPC, CPMA, CPC-I,

CRCStephanie McCrary, CICSue DeRousse, CPC, CEMCSusan Collins, CPC, CICSusan E Mittler, CPC, COSCSusan Fulton, CPBSusan Gray, CPC, CRCSusan M Harrigan, CPC, CRCSusan M Vail, CPC, CEMCSusan Wright, CPC, CEMCSuzanne Barone RN BSN, CPC, CRC

Sylvia Renee Valentine, CPC, CHONCTamara L Lucus, COC, CPC, CIRCC,

CPMA, CPC-I, CICTammy Jantz, CPBTammy L Mills, CPC, CPMATammy Letner, CPC, CPMATammy R Seel, CPC, CPMA, CEMCTammy Ware, CRCTanya L Watts, CPC, CEMCTanya Rebelo, CPC, CEDCTara Stone, CPC, CEMCTeena Smith, CPC, CUCTera Jennings, CPBTeresa Alexander, CRCTeresa L Schubert, CPC, CPCO, CPPMTeresa Maceri, CPC, CRCTerissia L Bell, COC, CPC, CICTerri L Parsley, CPC, CPMA, CGSCTheresa A Bilier, CPC, CRCTheresa Ann Cooney, CPC, CPBTheresa Barone, CPC, CRCTheresa Convery, CPC, CUCTheresa Giuliano-Mannino, CPC, CPB,

CPMAThomas Davis, CPCO, CRCThomasina L Young, CPC, CPCO, CPMA,

CRCTiffany Arrington, CPC, CIMCTiffany Gass, CPCOTina Nichols, COC, CPC, CPMA, CEDCToni Toone, CPC, CPMA, CPC-I, CRCTonya R Keys, CPC, CRCTracey Marie Wessen, COC, CPC, CPMA,

CCVTC, CEMC, CGSC, COBGCTracy A Rutan, CPC, CPB, CHONCTracy Camerlinck, CPC, CRCTracy Rinehart, CPC, CRCTrechell Y Schroeder, CPC, CPMA, COSCTrixie H Muggli, COC, CPC, CEMCTroy Michelle Thompson, COC, CPC,

CPMATwilla Yanak, CIRCCUmapati Mishra, CPC-A, CICValerie Murphy, CPC, CPMAVallerie Reyes, CICVicente Bituin, CICVicki Hess, CPC, CPBVicki J Marble, CPC, CPC-I, CRCVicki R McNeill, CPC, CRCVictoria James, CPC-A, CPMAVinutha Sameth, CPBVirginia Pona, CPC, CPMA, CRCWajeeha Akram, CPC, CPMAWendy Diane Atkins, CPC-A, CRCWendy Karen Gray, CPC, COBGCWhitney Barrington, CPC-A, CPBWilliam Edward Henderson, CPC, CRCWilliam Wong, CPC, CPMAYainelis Herrera Puentes, CPC-A, CPMAYvette Sheryl Langston, CPC, CPMA,

CEMCYvonne M Jackson, CPC, CRCYvonne Mendelson CCS, CPC, CPMA,

CRCZsuzsanna Barna, CPC, CRC


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