US

HEALTHCARE
BUSINESS MONTHLY
Coding | Billing | Auditing | Compliance | Practice Management
MS-DRG May Spell TROUBLE: 32

CMS looks at time for mechanical ventilation billing
Rock the Mock Audit: 48

Dont let an external audit keep you up at night
The Doctor Said What? 52

Have a laugh at ridiculous physician notes
April 2016
www.aapc.com
Anaheim
September 19-21, 2016
Disneyland Hotel
$695 $345 THROUGH MAY 31

12 CEUS | 2.5 DAYS
Atlantic City
October 6-8, 2016
Harrahs Atlantic City
Healthcare Business Monthly | April 2016
COVER | Coding/Billing | 35
Balance Billing: Is It Legal?

By Mary Pat Whaley, FACMPE, CPC
[contents]
Coding/Billing
Auditing/Compliance
Practice Management
28 CPT 2016: Percutaneous Biliary

Interventional Coding
48 Rock the Mock Audit
58 What (Not) to Wear

While Job Hunting
David Zielske, MD,

CIRCC, CCVTC, COC, CCC, CCS, RCC
Lisa Jensen, MHBL, FACMPE, CPC
John Verhovshek, MA, CPC

[continued on next page]
www.aapc.com
April 2016
Healthcare Business Monthly | April 2016 | contents

Added Edge
18
16 Search Online for Healthcare Business Monthly Articles

Michelle A. Dick
Coders Voice
20 CMS EHR Toolkit Gives a Glimpse into Potential Compliance Issues

Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P
Coding/Billing
18 Examine Integumentary and Musculoskeletal Coding Changes

42
26 Conquer Common Billing Errors

Judy A. Wilson, CPC, CPCO, CPPM, CPB, CPC-P, COC, CPC-I, CANPC
32 MS-DRG May Spell TROUBLE for Mechanical Ventilation Billin

Leonta (Lee) Williams, RHIT, CPC, CPCO, CCS, CCDS
38 The Ins and Outs of Inpatient Psychiatric Facility Perspective Payment

System

Heather Greene, MBA, RHIA, CPC, CPMA
Auditing/Compliance
42 The Latest on HIPAA: The Gun Check Rule

54
Sue Miller
44 2016 OIG Work Plan: Part B Risk Areas

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA
Practice Management
52 The Doctor Said What?

Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC
54 The Nine Cs of Clinical Documentation Improvement

COMING UP:
Member of the Year

MIPS Is Coming
New Chapter Association
Category III Codes
Influence Providers
On the Cover: To avoid the pitfalls of balance billing, Mary Pat Whaley,
FACMPE, CPC, explains how to stay in line with private carrier rules and
follow updated Medicare and Medicaid guidance. Cover image by istock.
com/DNY59. Cover design by Kamal Sarkar.
4
Healthcare Business Monthly
Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P
DEPARTMENTS
13 Local Chapter News
Letter from CEO
14 Ethics Committee
Letters to the Editor
66 Minute with a Member
Chat Room
I Am AAPC
10 AAPC National Advisory Board

12 AAPC Chapter Association
EDUCATION
60 Newly Credentialed Members
Online Test Yourself Earn 1 CEU
www.aapc.com/resources/publications/
healthcare-business-monthly/archive.aspx
Looking
to get
certified?
Students that complete our

courses are TWICE AS LIKELY
to pass the certification exam.
ICD-10 integrated and interactive lectures with all coding and billing courses.
CPC
COC
CIC
CRC
CPB
CPMA
CPPM
CPCO
For more information or to enroll visit:
www.aapc.com/exam-prep
Serving 155,000 Members Including You!
Go Green!
Why should you sign up to receive Healthcare Business Monthly in
digital format?
Here are some great reasons:
You will save a few trees.
You wont have to wait for issues to come in the mail.
You can read Healthcare Business Monthly on your computer, tablet, or
other mobile deviceanywhere, anytime.
You will always know where your issues are.
Digital issues take up a lot less room in your home or office than paper
issues.
vendor index
Go into your Profile on www.aapc.com and make the change!
American Medical Association.......................................13, 53

www.amastore.com
HealthcareBusinessOffice, LLC.............................................33
www.HealthcareBusinessOffice.com
ZHealth Publishing, LLC...................................................... 25
www.zhealthpublishing.com
HEALTHCARE
BUSINESS MONTHLY
April 2016
Director of Publishing
Brad Ericson, MPC, CPC, COSC
brad.ericson@aapc.com
Managing Editor
g.john.verhovshek@aapc.com
Editorial
Michelle A. Dick, BS
Renee Dustman, BS
Graphic Design
Mahfooz Alam
Kamal Sarkar
Advertising
Jon Valderama
jon.valderama@aapc.com
Address all inquires, contributions, and change of address notices to:

PO Box 704004
Salt Lake City, UT 84170
(800) 626-2633
2016 Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in
any form, without written permission from AAPC is prohibited. Contributions are welcome.
Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or
opinion are the responsibility of the authors alone and do not represent an opinion of AAPC,
or sponsoring organizations.
Ask the Legal Advisory Board

From HIPAAs 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! AAPCs Legal
Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to LAB@aapc.com and let
the legal professionals hash out the answers. Select Q&As will be published
in Healthcare Business Monthly.
Medical Coding Legal Advisory Committee:
Timothy P. Blanchard, JD, MHA, FHFMA
Julie E. Chicoine, JD, RN, CPC
Michael D. Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC
Christopher A. Parrella, JD, CPC, CHC
Robert A. Pelaia, Esq., CPC
Stacy Harper, JD, MHSA, CPC
CPT copyright 2015 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The
AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not
contained herein.
The responsibility for the content of any National Correct Coding Policy included in this
product is with the Centers for Medicare and Medicaid Services and no endorsement by the
AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.
CPT is a registered trademark of the American Medical Association.
CPC, COCTM, CPC-P, CPCOTM, CPMA, and CIRCC are registered trademarks of AAPC.
Volume 3
Number 4
April 1, 2016
Healthcare 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.
Letter from CEO
You Are AAPCs Strength

AAPC
is a membership organization, a collection of peers who help to improve healthcare for

the whole country through our expertise in managing the business of healthcare. Beginning this month, AAPC celebrates our roles and common goals a number of ways.
Be Part of the Fellowship at Conference

AAPCs annual national conference, HEALTHCON, runs April 10-13, at Disneys Coronado
Springs Resort in Orlando, Florida. In addition to sharing and learning about industry trends and solutions with other industry experts, attendees get the chance to make new friends and catch up with
old acquaintances. This fellowship is important to AAPC, and essential to members.
Also at HEALTHCON, we will celebrate both our 2015 Member of the Year and Chapter of the
Year. The Member of the Year is someone who not only exemplifies the professional values of
AAPC, but also has contributed to their colleagues success. The person were praising this year
has done all that and more, and Im excited to be a part of the celebration. The honorees will be featured in upcoming editions of Healthcare Business Monthly.
For those of you who cant make it to HEALTHCON this year, AAPC is also holding regional conferences in Anaheim, California, September 19-21, at the Disneyland Hotel, and in Atlantic City,
New Jersey, October 6-8, at Harrahs.
Local Chapters: Our Grassroots

AAPCs more than 500 local chapters are unique in our industry, and its in our chapters where
most of AAPCs networking happens. Few membership organizations can boast the enthusiasm
and dedication of our chapter officers and attendees. Chapter members are privy to interesting, insightful, and useful presentations; fun social events; and caring community projects put on by local
chapters all over the country. This years Chapter of the Year stands out, but does not stand alone.
Together, we are
raising the business
of healthcare to
new levels.
Get Excited for May MAYnia

Next month is May MAYnia, when all chapters open doors to new and existing members through
special activities and speakers. Chapters compete to increase attendance the most, so be certain to
attend your chapters meeting next month. If you havent taken advantage of the intelligence, support, and experience of your local chapter, try it! You have nothing to lose, and everything to gain.
You can find out where and when your local chapter meets on AAPCs website at www.aapc.com/localchapters/find-local-chapter.aspx.
Support Each Other and Strengthen Healthcare

Im grateful for the opportunity to meet many of you at these events. Our strength is our membership. I gather strength from you and what you do to make AAPC such a vital organization. There
are many new opportunities ahead of us, such as value-based payment, ongoing code updates, clinical documentation improvement, and other movements. Together, we are raising the business of
healthcare to new levels.
Sincerely,
Jason J. VandenAkker
CEO
www.aapc.com
April 2016
Please send your letters to the editor to:

letterstotheeditor@aapc.com
Letters to the Editor

HEALTHCARE
BUSINESS MONTHLY
March 2016
www.aapc.com
Michael S. Mix Up
Our apologies to Michael Strong, MSHA, MBA,

CPC, CEMC, and Michael Stearns, CPC,
CFPC, for getting their bio photos mixed up on
page 37 of the March edition.
Michael Strong, MSHA, MBA,
CPC, CEMC
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
March2016_HBM.indd 1
11/02/16 9:33 pm
Speak Up and Be Heard!
Do you have a question regarding information found in Healthcare Business Monthly?

Or maybe you have a difference in opinion you would like to share with your peers?
Write us at: letterstotheeditor@aapc.com.
Chat Room
Spreading AAPC Love

through Social Media
CHAT ROOM
If you post on AAPCs Facebook page, many

AAPC members and employees read your
threads. Our staff enjoys reading your posts
and appreciates your feedback especially
when you spread positive messages to fellow
members. Here are two posts that caught our
eye this month:
On February 15, Petersburg, Va., Local

Chapter President Cynthia Briggs CPC,
CPMA, shared a positive experience she had
with AAPC Customer Service Representative
Cindy Gigante. And later that month, our very
own Vice President of Strategic Development
Rhonda Buckholtz, CPC, CPCI, CPMA,
CRC, CHPSE, CENTC, CGSC, CPEDC,
COBGYN, took a moment to share her AAPC
pride. Thanks ladies for spreading the love!
Even Better Bronchoscopy in 2016

On page 24 of the March issue, in the article Better Bronchoscopy in 2016, the second paragraph lists the wrong deleted
code. CPT 61620 is not deleted; add-on code 31620 is deleted,
effective January 1, 2016.
LEANDREA ABERCROMBIE, CPC

I
always wanted to work in the medical field.

My original plan was to become a medical assistant and use that position to pay for
nursing school. Two years into working and
halfway through my bachelors degree program, I was diagnosed with systemic lupus
erythemosis.
racked up a huge tuition bill and ran up my

credit card with books and study materials.
My immune system forced me to consider a

new career, and medical coding seemed interesting.
I was psyched and decided to sit for the Certified Professional Coder (CPC) exam. Although I had been out of school for a year,
I was already working with codes and felt
fairly confident and ready. Unfortunately, I
failed by an earth-shattering 1 percent. The
road seemed so long, my career advancement was once again stalled, and I began
to question whether this was truly the career for me.
I finished school fairly quickly. A lot of the

classes were the same as a pre-nursing major,
but if anybody had bad luck, I felt like I did.
Hurdle One
One month before graduation, the government postponed the ICD-10 implementation; however, my school had already started
teaching ICD-10 because ICD-9 was slated
to be obsolete by graduation. This meant I
didnt know ICD-9 well enough to sit for a
certification exam.
Hurdle Two
My school was AHIMA accredited and
encouraged us to take the Certified Coding Specialist (CCS) test; however, the test
was suspended indefinitely within weeks
of graduation. All of my exam preparation
was in vain.
Hurdle Three
I had to self-teach myself ICD-9 because I
I began to work with a medical coder. She

stated that medical coding was a progressive career and that outpatient was the best
way to ease into the career and find where
my niche would be.
#IamAAPC
I Am AAPC
My husband believed I could pass and encouraged me to study. For four weeks, I
studied day and night. I applied my studies
to the coding I was doing at work. My husband and my father bought all the study materials AAPC had available. One month later, I passed the exam!
Jump Those Hurdles

and Never Give Up
It was all about not giving up and having a
strong desire to be in the field. I believe my
obstacles have shaped me to be committed
to the business side of healthcare and I am
extremely proud of having the letters CPC
behind my name.
#IamAAPC
Healthcare 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 (michelle.dick@aapc.com) or
Brad Ericson (brad.ericson@aapc.com).
#IamAAPC
www.aapc.com
April 2016
AAPC NATIONAL ADVISORY BOARD
Region 7 Mountain/Plains
Two representatives team up to promote, serve, and

support AAPC and its Region 7 members.
s a follow up to the January article The National Advisory

Board Is Here to Serve You, we are spotlighting each of the eight
regions and the National Advisory Board (NAB) members who represent them. In February, we featured Region 5 Southwest representatives; this month, were zoning in on Region 7.
Hamilton and Stephens have a one team philosophy, and they

are passionate about strengthening AAPC members and paying it
forward. I am passionate about everything I do, Stephens said at
the first NAB meeting. Thats what being a NAB member is about:
loving what you do and wanting to share it with everyone.
Region 7 - Mountain/Plains
Glenda Hamilton, CPC, COC, CPC-P, CPMA, CEMC
The Mountain/Plains region is comprised of Idaho, Utah, Arizona,

New Mexico, Montana, Wyoming, Colorado, North Dakota,
South Dakota, Nebraska, and Iowa. This region covers the largest
number of states, with 14,662 members and 64 chapters.
Glenda Hamilton, CPC, COC, CPC-P, CPMA, CEMC, and
Angelica Stephens, RHIT, CPC, COC, COSC, CPMA, CCS-P,
are the NAB representatives who promote, serve, and support
AAPC and its Region 7 members. These representatives are unique
in that they are from two totally opposite ends of the United States:
Albuquerque, New Mexico, and Cherry Hill, New Jersey. When
they became Region 7 representatives, it was like east meeting
west. Although they hale from opposite ends of the country, they
have the same professional goals.
10
Hamilton has more than 26

years of experience in practice
management, coding, reimbursement, education, auditing, and
consulting. She joined Cooper
University Hospital in 2005 as a
clinical documentation educator,
and is now senior compliance
auditor. Hamilton also runs her
own consulting business, offering
expert witnessing for attorneys.
Hamilton has been certified
since 2003. An active member of the Cherry Hill, New Jersey, local
Regional Spotlight
Angelica Stephens, RHIT, CPC, COC, COSC, CPMA, CCS-P

Stephens also obtained her first
certification in 2003. Over the
past 20 years, she has accrued
experience in coding, reimbursement, education, audits, and
management. Her career has
exposed her to several specialties,
but her favorite is orthopedics.
Always eager to learn, Stephens is
studying home health coding and
consulting for private practice.
NATIONAL ADVISORY BOARD
chapter, she has held multiple officer positions over the past 10
years, including vice president (twice), president (twice), member
development officer, and education officer. She assists others with
charitable acts and helps members to find jobs. Her professional
ethics have influenced current officers with great success.
Stephens worked as an auditor in a compliance department for

three years before taking on the role of revenue services manager
for an orthopedic practice in Albuquerque, New Mexico. She now
holds the position of member development officer of the Albuquerque, New Mexico, local chapter, and is a member of the advisory
board for the HIT Program at the local community college.
Making Region 7 Stronger

We hope you allow your NAB representatives to serve as a conduit
to AAPC to ensure your voice is heard and your needs are met.
Stephens and Hamilton are looking forward to meeting you at
HEALTHCON in Orlando, Florida, on April 10-13. Feel free
to contact these representatives any time to share positive or
negative feedback, seek guidance, or to just say, Hi! You can
reach Hamilton at glenda.hamilton@aapcnab.com and Stephens at angelica.
stephens@aapcnab.com.
You Wanted Low Priced CEUs?

How about $2.50 per Webinar!
+ 12 Months of Access to 40+ Live Events
& Entire Library of 100+ On-Demand

Webinars
+ Receive 2 CEUs per Webinar
(Live & On-Demand)

+ Topics Cover 21+ Specialties
+ 12-Month Subscription Starting at $295
(Volume Discounting Available for Your Office)
800-626-2633
aapc.com/webinars
www.aapc.com
April 2016
11
AAPC Chapter Association

By Judy A. Wilson, CPC, CPCO, CPPM, COC, CPC-P, CPB, CANPC, CPC-I
Experiencing
Hard Times
T H ER ES H EL P
ife can throw you curve balls. Most of the

time, you dodge them or knock them out of
the ball park. But when one knocks you for a
loop, and you need help getting back on your
feet, look no further than your AAPC local
chapter. Whether you find yourself homeless
because of a natural disaster or experiencing financial difficulty due to illness, your
chapter officers will gladly help you apply for
assistance through Project AAPC and the
Hardship Scholarship Fund.
Project AAPC
Established in 2010, Project AAPC further developed former AAPC Chapter Association Chair Jill Youngs, CPC, CEDC,
CIMC, vision for chapter members to help
one another by donating to the American
Red Cross or Feeding America after a devastating event. Project AAPC donated more
than $10,000 to those organizations during the Nashville floods of 2010, all of which
was collected by AAPC members and AAPC
staff. After finding out that some of our
members were unable to get the help they
needed from those organizations, the AAPC
Chapter Association board decided to donate
all Project AAPC money directly to chapter members in need. Project AAPC assists
chapter members with money for food, lodging, and basic necessities when there is a proven need.
Since its inception, Project AAPC has helped
many chapter members subjected to a devastating event. For example:
Members recently affected by the
South Carolina flood;
A member with a severe illness
preventing her from working; and
12
Project AAPC and the Hardship

Scholarship Fund are here to
help chapter members.
A member who couldnt afford a bus

pass to get back and forth to work.
Hardship Scholarship Fund

The Hardship Scholarship Fund was established in 2012 to help chapter members who
have fallen on difficult times due to loss of
job or the inability to find a job. The financial help is used for members to keep their
credentials, and can be applied to the cost of
the ICD-10-CM proficiency exam, renewing
national memberships, or purchasing coding books.
The Hardship Scholarship Fund is not given for
additional credentials or non-essential needs.
It provides for AAPC educational services,
books, etc., but it does not cover workshops
through AAPC or other organizations. This
funds main purpose is to help struggling
chapter members keep the original credential
they worked so hard to obtain.
Some things to keep in mind when applying
for this fund:
You must be an AAPC member in
good standing.
You must be active in your local chapter.
Consider first reaching out to your
local chapter for a scholarship.
To date, the Hardship Scholarship Fund
has helped over 336 members, at a cost of
$55,333.85, and more than $103,220.19 has
been contributed to the fund.
How to Apply
The application for the Hardship Scholarship Fund can be found on AAPCs official
website at www.aapc.com/memberarea/chapters/
scholarship-application.aspx. Remember to be
specific in the application about what you

are doing for yourself and why exactly you
need help. There is always hope and support,
so please reach out when it is needed by you
or another chapter member.
Pay It Forward
The Scholarship Application Review
Committee is made up of past AAPC
Chapter Association board members serving
in an anonymous and voluntary role. This
ensures the process is fair to all. The funds
are supported through donations made by
members and local chapters. If funds run
too low, the ability to grant scholarships will
be put on hold until more funds become
available. Talk to your chapter about
budgeting for a gift to these funds, so we can
keep helping our members who are in need.
You can also make a personal donation.
Personal donations should be in the form
of a check, payable to the AAPCCA Hardship Scholarship Fund or Project AAPC, and
mailed to:
AAPCCA-Project AAPC/
AAPCCA-Hardship Scholarship Fund
2233 S. Presidents Drive
Salt Lake City, UT 84120
Judy A. Wilson, CPC, COC, CPCO, CPPM, CPC-P,
CPB, CPC-I, CANPC, has been a medical coder/biller for
more than 35 years. For the past 25 years she has been
the business administrator for Anesthesia Specialists, a
group of nine cardiac anesthesiologists who practice at
Sentara Heart Hospital. Wilson served on the AAPC Chapter Association
board of director from 2010- 2014, and is serving from 2015-2017. She is
also on the board of directors of Bryant & Stratton College in Virginia
Beach, Va. Wilson is a PMCC instructor and teaches classes in the Tidewater area. She serves on the National Advisory Board for American Academy
of Billers for AMBA, has presented at several AAPC regional and national
conferences, and is a member of the Chesapeake, Va., local chapter.
Local Chapter News
Houstons New Year Celebration Fosters Success

The Houston, Texas, local chapter kicked
off 2016 with a Happy New Year! theme
chapter meeting. The entire chapter was
very excited about the first meeting of 2016,
which everyone agreed was a success.
President Drieca D. Hopkins, CPC, CBCS,
said, Our speaker for the evening, Steven
Woods, SHR-CP, PHR, did an awesome presentation called Preparing Your Resume for
the Job You Want, Not the Job You Had.
According to Hopkins, It was beneficial for
seasoned coders as well as newbies, giving
us great tips on resume writing and what recruiters expect to see on resumes. Houston
also had a recruiter from K-Force present and
share career opportunities.
Houstons Member Development Officer
Carmen Chaisson-Hunt, CPC, was instrumental in sharing multiple job opportunities with the attendees, as well as creating the chapters Facebook page. As a returning officer, Hopkins said she is excited for a
complete new board for 2016 sharing new

and bright ideas.
The chapter made a toast to 2016 with a little
bit of the bubbly (sparkling cider). It was a
great time of mixing and mingling; it was informative, as well as fun, said Hopkins.
We want our meetings to be informative,

engaging, and fun! Our goal is to get more
member involvement, educate more on ICD10, promote certification, and be a BIG help
to our uncertified members, said Hopkins.
Thats the way they do things in Texas: BIG!
Houston rings in the new

year with Instagram selfies.
Houston classes it up with

fancy meeting flyers.
Houston shows members that

everything is bigger in Texas,
even local chapter meetings.
Crack specialty coding with the American Medical

Associations 2016 CPT Coding Essentials seriesthe
perfect companion to your CPT Professional codebook
This six-book series comes straight from the source of CPT codethe AMAand exclusively provides
the CPT Editorial Panels Guidelines instructions on ICD-10-CM documentation and coding.
To learn more, visit amastore.com or call (800) 621.8335.

Series includes:
Cardiology 2016
General Surgery & Gastroenterology 2016
Obstetrics and Gynecology 2016
Ophthalmology 2016
Orthopedics: Lower Extremities 2016
Orthopedics: Upper Extremities And Spine 2016
www.aapc.com
April 2016
13
AAPC
Ethics Committee
By Michael D. Miscoe, JD, CPC,
CASCC, CUC, CCPC, CPCO, CPMA
A Question of
I have noticed AAPC has an abundance of information regarding coder

ethics, but not very much information of how the ethical coder is to react
in a not-so-ethical environment.
Many of the coders I know are employed in an environment where ethics fall far below productivity on the scale of importance. How are we to
stand up to this type of pressure? We are repeatedly beaten down for productivity numbers, and the terms quality, accuracy, and integrity
are not even part of the vocabulary.
Its all well and good to demand a level of ethics of your membership, but
your membership has to be able to work under circumstances that are
quite a different story. And the membership needs to work to pay your
dues. Why do you constantly pander to the health systems and push the
ethical agenda? The members are paying the dues, give us recourse to
do what is ethical.
Be ethical, be respectful, be responsible. But please, tell us how to deal
with monopoly health systems who dont care about our ethics or if we are
employed and able to pay our membership dues, but still expect us to be
caring people, caring for people.
Thank you for your question. You raise an excellent issue. There are
often competing demands and your commitment to professional and
ethical behavior will help you make correct choices. I would point out
that the AAPC Code of Ethics addresses more than just the quality
of your professional work. Although I understand that the demands
of productivity can sometimes impact quality, the Code of Ethics is
not designed to punish mistakes. And while you should strive to be
both efficient and accurate, there is a breaking point. Thats your employers problem, not yours. When youre pushed to be more productive, its likely that quality and accuracy will suffer. If that is the case,
your obligation is merely to raise the issue with your employer. If they
are willing to compromise quality for perceived productivity, so be it.
You have met your obligation by raising the concern. Because your
employer, as an entity, is not likely subject to the AAPC Code of Ethics, you cant make them do the right thing. Thats the job of law enforcement and/or carrier special investigative units.
The Ethics Committee would never waste time on a case where your
coding was deemed inaccurate because you werent given sufficient
time to do your job properly, especially where you expressed the con14
cern with your employer. The impact of those mistakes will fall
where they belong, on the practice. The practice will be forced to refund overpayments or may suffer payment delays or denials because
of those mistakes. Although the practice may seek to place the blame
on you for the errors, the evidence of your previously-raised concerns
would undermine such allegations. Relative to your work as a coder,
the Code of Ethics would come into play only if you purposefully or
negligently misrepresented services for the purpose of receiving some
personal benefit. That doesnt seem to be the issue here.
Productivity improvement and efficiency are not improper goals
for any organization; they are key to profitability. There is a balance, however, that must be found. At some point, pure productivity
based on how many claims you must code becomes counterproductive when you have insufficient time to ensure codes reported are justified or accurate.
As to your question relative to the motive behind the Code of Ethics, its in no way a form of pandering. AAPC members can be found
working on behalf of providers, payers, and the government. Our ethical standards exist because we cannot call ourselves a professional organization without them. All professions impose and enforce ethical
standards on their members. Our commitment to ethical conduct,
as well as educational standards as measured through testing, is what
separates us from others who have not had to demonstrate their competence in the areas of coding, billing, auditing, practice management, or compliance. For that reason, AAPC credentialed members
have more value in the marketplace. Ultimately, you are the only person who can determine how you will act or react in a given circumstance. The Code of Ethics is a guide to help ensure you act or react
in a professional manner.
Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of
AAPCs National Advisory Board, serves on AAPCs 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 experience in healthcare coding
and over 18 years as a forensic 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-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.
istock.com/travellinglight
What do you do when

coding productivity is
more important than
ethics at your workplace?
Free 14 Day Trial

The premier online coding tool from the largest
coding credentialing organization.
Lay Descriptions
CPT Crosswalks
ICD-10 Bridges
Fee Schedules
NCDs & RVUs
Survival Guides
Real Time Claim Scrubber
CPT Modifiers
ICD-9 Crosswalks
CCI Edits Checker
Medicare LCD lookup
CMS Transmittals
Specialty Newsletters
EARN UP TO
20 CEUs
WITH YOUR ANNUAL
SUBSCRIPTION
I find the CMS 1500 claim edit

checker to be the most helpful tool ever
created by coding-mankind. I also love the
fact that everything is in one place:
LCD, NCCI edits, Fee Schedule, etc.
Vanessa M.
Start Your FREE Trial Today!

Visit aapc.com/coder today
or call 800-626-2633
ADDED EDGE
By Michelle A. Dick
Search Online for Healthcare Business Monthly articles

Looking for guidance on a particular topic you remember
seeing in our magazine? Heres how to find it on the Web.
hether youre stuck on a particular code,

modifier, or bundling rules, or have limited resources to find guidance unique to
your specialty, chances are the answers you
seek are somewhere in Healthcare Business
Monthlys archives. AAPC makes it easy for
you to find the article youre looking for online.
Be sure to use the second search box, not

the one at the very top of the Web page.
Its at Your Fingertips

Many times members contact us, asking:
I remember reading an article in
Healthcare Business Monthly magazine
about a year ago with guidance on
code Can you email me the article?
or
Do you have information on
interventional radiology? I think I saw
guidance in a past issue, and Id like to
use it for a presentation handout.
In fact, all Healthcare Business Monthly
articles are on the AAPC website in the
News & Blog section, and you can search
through them using keywords.
For example, you remember recently seeing
guidance on percutaneous vertebroplasty
CPT code 22510, but cant remember
what article or month it appeared in the
magazine. Heres how to find the article:
Log on to AAPCs website using your
user name and password.
Go to the News & Blog Web page at:
www.aapc.com/blog/.
On the right side of the Web page,
under the blue tabs across the top,
theres a search engine text box labeled
Search Blog.
Type 22510 in the Search Blog text
box and then click on the magnifying
glass search symbol next to it.
16
Tip: Be sure not to type the code in the

search box at the very top of the page. That
box will search the entire AAPC website,
not just the news and article feeds. Type in
the box shown in above.
All articles and news blogs that have
the keyword 22510 in it will display,
such as Vertebroplasty Quick Coding
Guide, Solidify Your Vertebroplasty
and Kyphoplasty Coding, CPT
2015: Sizable Changes for Drug
Testing Codes and Others, and
Vertebroplasty Is Not Vertebral
Augmentation. Click on the link to
read the article.
Narrow Your Search

To display only Healthcare Business Monthly
articles, there is a pull-down menu on the
www.aapc.com/blog/ page under the Search
Blog text box labeled Other Categories.
Hover your mouse over it and youll see
Healthcare Business Monthly Archive.
Click on it and your search will be limited to
only magazine articles.
Under the Other Categories pull-down

menu, you can also search by certain topics.
For example, Coding Blog, Auditing Blog,
Client Services, ICD-10, Home Health,
CMS, Infographics, etc.
Always Check Your Sources

You should always verify all coding
guidance found on AAPC.com and other
coding websites with original sources (i.e.,
government regulations, payer guidance,
CPT, ICD-10, HCPCS Level II, specialty
societies, etc.) before taking the advice.
We hope you enjoy using our site as a
research tool for your next coding, auditing,
or practice management challenge.
Michelle A. Dick is executive editor at AAPC.
Access Your AAPC Passport Savings Today!

Its
as
easy
as
Its
as
easy
as
Its
as easy
as
1 Register
at aapc.com/passport
1
1
2
2
2
3
3
3
Register at aapc.com/passport
Register at aapc.com/passport
Download the Passport mobile app
Login and save!
Login and save!
Login and save!
Visit aapc.com/passport to register for your Passport number. Youll

Visit
to register
for your
PassportYour
number.
Youll
needaapc.com/passport
the unique AAPC code:
ATBOHC15
to register.
Passport
Visit aapc.com/passport to register for your Passport number. Youll
need
thewill
unique
AAPC code:
ATBOHC15 to register. Your Passport
number
be emailed
to you.
need
thewill
unique
AAPC code:
ATBOHC15 to register. Your Passport
number
be emailed
to you.
number will be emailed to you.
Download the Passport mobile app by searching for Passport Mobile
Download the Passport mobile app by searching for Passport Mobile

in your phones marketplace.
Download
the Passport
mobile app by searching for Passport Mobile
in your phones
marketplace.
in your phones marketplace.
Enter your Passport number and start saving!

In addition to the mobile app, you can view participating savings by
In
addition
to the mobile app, you can view participating savings by
visiting
https://aapc.passportcorporate.com
In
addition
to the mobile app, you can view participating savings by
visiting
https://aapc.passportcorporate.com
visiting https://aapc.passportcorporate.com
CODING/BILLING
By John Verhovshek, MA, CPC
Examine Integumentary and

Musculoskeletal Coding Changes
Overlooking minor changes can be a costly mistake.
ithin the Surgery section of CPT, the new year brings just two
new Integumentary codes, and deletes a single Musculoskeletal code. Minor changes such as these are easy to overlook, but costly to ignore.
Integumentary Updates
Fiducial markers serve as radiologic landmarks. Using imaging guidance, each marker is placed in or near a tumor and becomes the target to facilitate precise delivery of radiation treatments. CPT adds
two codes to describe placement of these devices:
10035
+10036
Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive
seeds), percutaneous, including imaging guidance; first lesion
each additional lesion (List separately in addition to code for primary procedure)
Report 10035 and 10036 per lesion, not per marker (several markers
may be placed per lesion). Claim 10035 for placement of soft tissue
markers at an initial lesion and +10036 for each additional lesion targeted beyond the first.
The American Medical Associations (AMA) CPT Changes 2016: An
Insiders View provides an example of proper application for 10035:
A 62-year-old female presents with previously biopsied left
axillary lymph node metastases secondary to invasive ductal
breast carcinoma. She is now referred for neoadjuvant chemotherapy. Marking of the positive lymph node is requested
prior to the initiation of neoadjuvant chemotherapy.
istock.com/kot63
Note that CPT includes several codes that specifically describe

placement of localization devices in the breast, either with (1908119086) or without (19281-19288) biopsy. CPT Changes 2016 clarifies, 10035 and 10036 have been established to capture marker
placements into areas such as the axilla and/or groin tissue. Do not
report 10035/10036 if 19081-19086 or 19281-19288 better describe
the location of the marker.
Per CPT Assistant (May 2015):
To report bilateral image-guided breast biopsies, report
code 19081, 19083, or 19085 [depending on the type of
imaging used; e.g., stereotactic, ultrasound, or MRI] for
the initial biopsy. The contralateral image-guided breast
18
Coding/Billing
Auditing/Compliance
Practice Management
To discuss this
article or topic, go to
www.aapc.com
Marker placement includes imaging guidance. Do not separately report:
CODING/BILLING
istock.com//elnur
biopsy and each additional image-guided breast

biopsy are then reported with code 19082, 19084,
or 19086. Similarly, to report bilateral marker
placement, report code 19281, 19283, or 19285
[again, depending on the type of imaging used] for the initial
marker placement. The contralateral and each additional breast
image-guided marker placement are then reported with code 19282,
19284, or 19286.
Integumentary/Musculoskeletal
Code 21805, which previously

described open treatment of rib
fracture without fixation, is deleted
for 2016 as an obsolete service.
76942
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
77002
Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
77012
Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization
device), radiological supervision and interpretation
77021
Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
There are no guideline or parenthetical instruction revisions in the Integumentary chapter for 2016.
Open Treatment of Rib Fracture Is No Longer Supported

Code 21805, which previously described open treatment of rib fracture without
fixation, is deleted for 2016 as an obsolete service. CPT Changes 2016 explains,
In current practice, when an injured rib is treated in an open fashion, it is either
resected or treated with some form of internal fixation. Because existing codes for
open rib fixation and codes for rib excision (21600) may be used to identify open
rib treatments, code 21805 has been deleted without replacement
Instruction in the CPT codebook tells us to report 21899 Unlisted procedure, neck
or thorax for external rib fixation. CPT further directs us to report an evaluation
and management (E/M) service for closed treatment of an uncomplicated rib fracture (e.g., the fracture is reduced without surgical intervention). Turn to 2181121813 for open (surgical) treatment of rib fracture(s) with internal fixation (the
use of plates, screws, nails, and wires to stabilize the rib fracture).
There are no guideline or parenthetical instruction revisions in the Musculoskeletal chapter for 2016.
John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.
www.aapc.com
April 2016
19
CODING/BILLING
By Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P
Coders Voice
istock.com/pandpstock
CMS EHR Toolkit Gives a Glimpse

into Potential Compliance Issues
The toolkit clarifies risks and

provides guidance, but more can
be done to address software and
user pitfalls.
20
Without any fanfare, the Centers for Medicare & Medicaid Services (CMS) last year published its Electronic Health Records Toolkit,
offering coders, facilities, and providers a glimpse of the regulatory
risks that CMS assigns to improper EHR use. Anyone with an EHR
who hasnt reviewed the CMS documents should access the Toolkit
and distribute all or parts of it to providers, coders, and legal counsel, as appropriate.
Although the Toolkit falls short of answering many questions regarding documentation and coding compliance, it gives a glimpse into
what CMS considers the important regulatory issues associated with
electronic records, and provides some rudimentary guidance.
Coding/Billing
Auditing/Compliance
Practice Management
CMS Toolkit
CODING/BILLING
For example, the Toolkit file, Ensuring Proper Use of Electronic

Health Record Features and Capabilities: A Decision Table, states
these best practices:
providers must recognize each encounter as a
stand-alone record, and ensure the documentation
for that encounter reflects the level of service actually
provided.
It further recommends creation of an internal policy, in which:
providers should weigh efficiency against the
potential for inaccurate, fraudulent, or unmanageable
documentation.
Regarding authorship of an EHR entry, the Toolkit advises:
Each entry not solely authored by the user must
be validated in a manner similar to bibliographic
notations and include the name, date, time, and source
of the data. This can be satisfied by system software
design that routinely provides validation.
Documents in the CMS Electronic Health Records Toolkit include:
Program Integrity Issues in Electronic Health Records: An
Overview
Resource Handout Resources for Program Integrity in
Electronic Health Records
Detecting and Responding to Fraud, Waste, and Abuse
Associated With the Use of Electronic Health Records
Booklist
Preparing for and Responding to Audits of Electronic
Health Records Checklist
Detecting and Investigating Unauthorized Access to
Electronic Health Records A Case Study
Compliance Checklist for Electronic Health Records
A Compliance Program for Electronic Health Records Fact
Sheet
Ensuring Proper Use of Electronic Health Record Features
and Capabilities: A Decision Table
Documentation Integrity in Electronic Health Records
Conducting Internal Monitoring and Auditing Job Aid
Manual Review of Electronic Health Records Job Aid
Although CMS waited six years

after HITECH to publish its first EHR
guidance, the CMS Toolkit remains
fuzzy in its vision regarding clinical
documentation and coding issues
relating to EHRs.
CMS Hasnt Defined Clinical Documentation Expectations
CMS became a key player in the EHR arena in 2009, when the
federal government enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of
the American Recovery and Reinvestment Act. HITECH was designed to stimulate adoption of EHRs capable of advancements in
patient care quality, including e-prescribing and interoperability. Incentives of up to $44,000 per provider were offered for timely implementation of EHRs, along with a small penalty of approximately $500 per year for Medicare-participating providers who
failed to implement compliant EHR systems within the CMS
timeline.
The Office of the National Coordinator for Health Information
Technology (ONC) developed an EHR certification program to
limit risks to providers and facilities shopping for EHRs, and to ensure providers receiving the incentive purchase legitimate EHRs.
The ONC certification covers issues identified by the U.S. Department of Health and Human Services (HHS) as critical to national EHR success, mostly involving format structure that is easily transmitted and retrieved, but that is also secure and private and
has meaningful use.
These certification programs were in place when EHR purchases
under HITECH began, but its important to understand that the
EHR certification criteria predominantly address administrative
and information technology-related content. Some clinical issues
were included when they satisfied HHS initiatives such as performance measures and e-prescribing; however, certification failed to
www.aapc.com
April 2016
21
CMS Toolkit
CODING/BILLING
Top EHR Misconceptions

You can improve your income with
electronic health records (EHRs).
Automated E/M levelers in EHRs save

time and ensure optimal coding levels.
Vendors may promise EHRs provide an easy way to cut costs

by reducing the number of employees needed in a practice,
and increase income by improving provider productivity.
Although the need for file clerks may be reduced with EHRs,
the number of coders, schedulers, and other office personnel
will likely remain steady, or grow. Increased productivity may
come with time, but to date this either hasnt panned out in
the short term for most practices, or has resulted from noncompliant up-coding.
Some EHRs will automatically calculate the E/M level for

an office visit, but because issues of medical necessity and
failure to require qualitative features in the history of present
illness; review of systems; past, family, and social history;
physical exam; and clinical assessment, the EHR coding is
unlikely to fare well in an audit.
What EHRs should provide is enhanced levels of patient care,

easier use of some mandated programs, increased efficiency
in compliant documentation and coding practices, and safeguards for patient health.
Youre stuck with the features in an EHR.

Many of the documentation features within an EHR can be
edited by your information technology team or the vendor. If
a feature is being misused or is simply one that you suspect
may not be compliant, modify the system. EHRs are modifiable. Vendors may require a significant fee for modifications.
Many providers and coders today cite

degradation of the clinical record as a
result of templates, micros, macros, and
copy/paste, and are looking for a fix.
address non-compliant, day-to-day coding and clinical documentation features in EHRs, which focused on time-saving macros (often mislabeled as templates) and quick-pick lists of codes. Certification had little to do with clinical documentation excellence or
coding accuracy and compliance; some clinical and coding advocates are hopeful that the Toolkit will fix some of that deficiency.
Although CMS waited six years after HITECH to publish its
first EHR guidance, the CMS Toolkit remains fuzzy in its vision regarding clinical documentation and coding issues relating
to EHRs. For example, with the EHR feature called populating
by default, a review of systems (ROS) or physical exam is already
filled out for the provider for a new date of service. The form shows
all systems are normal. The provider changes only the systems having abnormalities in the review or exam.
The problem with populating by default is that it reports work
the provider may not have performed because it assumes all body
systems were reviewed and a complete physical exam was performed. This plays havoc with evaluation and management (E/M)
leveling.
22
All features within a government

certified EHR are acceptable to all
payers.
Many EHR features raise compliance questions. The U.S.
Department of Health and Human Services sent a letter to
U.S. hospitals in September 2012 stating that the cut-andpaste feature of some EHRs risks medical errors as well as
overpayments, and said, CMS has the authority to address
inappropriate increases in coding intensity in its payment
rules and CMS will consider future payment reductions as
warranted We will continue to escalate our efforts to
prevent fraud.
Just because a feature is available in a certified EHR does not
make it compliant with payer rules. Have your compliance
department review the documentation and coding performed through your EHR.
Although stating that populating by default may result in the reporting of services that were not delivered, the Toolkit falls short
of outlawing population by default; instead, saying the provider should verify the validity of auto-populated information. It offers no best practices solution for populating by default, although a
simple best practice might be to turn off this function in the EHR.
EHR Problem Areas to Watch

In some instances, in Ensuring Proper Use of Electronic Health
Record Features and Capabilities: A Decision Table, CMS states
in the best practices field that there are none to report at this
time. Its not known whether we can look to CMS for more detailed
and helpful guidance in the future. Many providers and coders today cite degradation of the clinical record as a result of templates,
micros, macros, and copy/paste, and are looking for a fix.
The medical record is becoming so large and unwieldy as to be indecipherable, Steven J. Stack, MD, chair of the American Medical Association (AMA), said in an address to CMS in 2013. CMS
should provide clear and direct guidance to physicians concerning
the permissible use of EHR clinical documentation for the purposes of coding and billing.
EHR improvement aligns with CMS goals, too. The Evaluation
and Management Services Guide issued by CMS states:
Clear and concise medical record documentation is
critical to providing patients with quality care and is
required in order for providers to receive accurate and
timely payment for furnished services. Medical records
CMS Toolkit
EHRs include current codes from the major code sets, and
providers can use these lists to code encounters and either
submit these codes directly or have them reviewed by
coding/billing staff before submission. But nearly all systems
lack code instructions, guidelines, and information from
Coding Clinic or CPT Assistant. Most providers are not certified coders and do not have the breadth of understanding
to select codes compliantly. Truncated code descriptions in
some EHRs also contribute to coding errors.
Certified coders should be excluded from

EHR selection teams.
Some vendors exclude coding staff from EHR selection, and
suggest that certified coders are not qualified or interested.
Neither is true. Coders can help providers and office manag-
ers understand the coding and compliance implications of

EHR features. Their input is crucial to successful coding following implementation.
EHR templates (i.e., macros) provide

more detailed documentation.
EHRs certainly provide more documentation, but not necessarily more detail. EHR templates catalog body systems and
most allow the provider to select a button stating the system
is normal or abnormal, or yes or no. Free text, where providers can enrich the record by describing qualitative details, is
limited in most EHRs. Instead of stating yes to shortness of
breath (SOB), free text allows the provider to state, SOB on
exertion. Says he can no longer negotiate stairs at home, and
became dyspneic in relating this to me. O2 on room air was
87. It is the qualitative information within the health record
that provides the most information to clinicians and coders.
chronologically report the care a patient received

and are used to record pertinent facts, findings
and observations about the patients health history.
Medical record documentation assists physicians
and other health care professionals in evaluating
and planning the patients immediate treatment and
monitoring the patients health care over time.
Stephen Levinson, MD, CHCA, author of AMA publications
Practical E/M and Practical EHR, identifies five intrinsically flawed
design and functionality features that are prevalent in most current
EHRs. These flaws, according to Levinson, are capable of disrupting both compliance and physicians medical diagnostic process:
1. Failure to consider medical necessity (which Medicare defines
as the overarching criterion for payment) into guidance for
appropriate levels of care, documentation, and code selection.
According to the AMAs CPT guidelines for E/M, considering
(and documenting) the nature of the presenting problem(s) provides confirmation and support for medical necessity.
2. Failure to guide and require documentation of the qualitative
(i.e., individualized descriptive) aspects of care as defined in
1997 Documentation Guidelines.
Required qualitative data includes, for:
Chief compliant: stated in the patients own words
(rather than a forwarded copy of previously entered
diagnosis);
HPI: the chronological description of the course of the
patients illness;
Purchasing a federally certified EHR

ensures it will be completely compliant.
CODING/BILLING
Providers can save time and money using

EHR coding pick lists or coding prompts.
Certified EHRs are equipped with software that makes them

compliant with portability, privacy, and security requirements, as well as some clinical tools including tracking
preventive care and performance measures and the ability
to detect and advise about prescriptions that could cause
allergic or drug interactions. Certified EHRs are not equipped
to contribute in any meaningful way to clinical documentation or coding compliance, and most do not follow the 1997
Documentation Guidelines for Evaluation and Management
Services, the CMS policy on medical necessity as overarching
criteria for E/M and payment, or avoidance of cloning practices and templates as outlined in documents published by
CMS beginning in 1999 and continuing to 2015.
PFHS and ROS: supplementing with pertinent positive

and negative responses to inquiries about details of the
positive responses to questions in these history areas;
PE: specific abnormal and relevant negative findings; and
Clinical assessment: patient-specific and visit-specific
descriptions of diagnoses (e.g., location, severity, extent, and
status relevant to previous encounters).
3. Non-compliant coding engines (based on the non-sanctioned,
incomplete, and non-compliant scoring sheet introduced as a
coding short cut in 1995.
4. Use of data entry shortcuts that create non-compliant cloned
pseudo documentation through automated function.
5. Use of data entry shortcuts that replace documentation of clinical assessment (i.e., impressions) with ICD billing language
and codes, a process that limits clinical descriptions and eliminates documentation of differential diagnoses.
These EHR documentation problem areas should be identified and
addressed because they are subject to the financial and emotional devastation of negative Medicare or Office of Inspector General (OIG) audits.
Levinson also advises, It is important to distinguish between EHR
utilization of (compliant) templates vs. (non-compliant) macros.
Templates are pre-loaded frameworks that include history questions to be asked with individualized documentation of the responses or exam elements to be examined with individualized documentation of the findings.
www.aapc.com
April 2016
23
CMS Toolkit
To discuss this
www.aapc.com
Macros include the templated questions, plus pre-loaded generic negative history responses and normal exam findings As automatic or single-click tools, the macro loads a completed clinical document before the patient has even been evaluated, Levinson said.
Levinson also emphasizes that coders and auditors require comprehensive and compliant tools that consider medical necessity when reviewing EHR documentation and coding. The commonly-employed, non-compliant scoring sheet not only offers inadequate and incorrect E/M coding in paper records, but it completely lacks tools to address the aforementioned five deficiencies
of EHRs. Practical E/Ms compliant audit forms for paper charts
were published as part of a CD accompanying the second edition of
Practical E/M in 2008. These forms were subsequently enhanced
to consider all the above EHR danger areas; PDFs of these coding
and audit charts were made available through AAPC in conjunction with Levinsons 2013 AAPC Workshop, Advanced E/M Coding for EHRs (www.aapc.com/workshops/em-coding-ehr.aspx).
Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P, is a coding education and risk adjustment
consultant and author of the AMA publication, Netters Atlas of Surgical Anatomy for CPT
Coding. Her 20-year career in coding and reimbursement includes developing coding curriculum and references for AAPC, the AMA, DecisionHealth, Elsevier, Optum360, and Staywell.
Bernard is a member of the Salt Lake City, Utah, local chapter.
Resources
CMS, Electronic Health Records Toolkit, Program Integrity: Electronic Health Records
files: www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrity-Education/electronic-health-records.html
CMS, Ensuring Proper Use of Electronic Health Record Features and Capabilities: A
Decision Table, Table 1: www.cms.gov/Medicare-Medicaid-Coordination/FraudPrevention/Medicaid-Integrity-Education/Downloads/ehr-decision-table.pdf
CMS, Medicare Learning Network, Evaluation and Management Services Guide: www.
cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/
downloads/eval_mgmt_serv_guide-ICN006764.pdf
24
istock.com/MKurtbas
CODING/BILLING
These EHR documentation problem areas should be

identified and addressed because they are subject to
the financial and emotional devastation of negative
Medicare or Office of Inspector General (OIG) audits.
CODING/BILLING
By Judy A. Wilson, CPC, CPCO, CPPM, CPB, CPC-P, COC, CPC-I, CANPC
Conquer Common
BILLING ERRORS
inancial problems can be directly related to billing errors that could

have been avoided simply by reviewing information. Errors can
cause delayed payment, costly fines, and lost revenue if not caught.
Lets take a look at a few of the top billing errors, and discuss how to
prevent them.
Verify Insurance
The number one reason, by far, for denied claims is failure to verify
insurance. Some of the common denials associated with not verifying insurance information are:
1. Subscriber is not eligible on the date of service.
2. S ervices are not covered or maximum benefits have been met.
3. S ervices were not authorized or authorization is required.
When you see these denials, I am sure you ask, Why didnt someone take care of this before we filed the claim? With people changing jobs and moving more often, insurance information can change
at any time. For this reason alone, your office should verify a patients
insurance eligibility at every visit.
26
For example, you might establish parameters in your billing practice

disallowing a claim that requires a pre-authorization to be filed without the authorization number. At the very least, a person should call
carriers on every patient prior to a procedure to verify eligibility and
the limits of the patients benefits. It takes a little longer, but its well
worth the extra time on the front end.
Remember: Each time you start over with a claim, you are losing
money and filing inaccurate claims.
Be Sure Your Information Is Complete

Another common error is inaccurate or incomplete patient information. Even the smallest error in a patients name can get a claim denied. This is why your front desk person is a valuable employee: He or
she can help to reduce denials by checking to make sure the patients
name is spelled correctly and that you have the right date of birth and
sex (for starters). The front desk person can also verify if the policy is
valid and if you need a group number or authorization number prior
to processing the claim.
Coding/Billing
Auditing/Compliance
Practice Management
istock.com/dina2001
Avoid three frequent

billing blunders to keep
revenue streams flowing.
Billing Errors
Be sure authorizations obtained are for procedures performed, and

procedure codes and diagnostic codes reflect as much. This is another common billing error that is easily corrected by taking the time to
look over the claim before processing.
Always use the most current coding books. Some offices may think
that its too expensive to get new books every year, but claim denials
can be much more costly. Criminal allegations may arise if you use
procedure and diagnosis codes incorrectly.
If the provider is still using handwritten charts and their writing is
illegible, you cannot transcribe what you think the documentation
says. If its incorrect, you now have a false claim. This is where the
electronic health record has helped to reduce billing errors.
Avoid Duplicate Billing

Lastly, lets look at duplicated billing, as this is a very common billing error, as well.
Duplicate billing for the same procedure or treatments is considered
fraud, and a practice can be fined for duplicate billing. If a claim is
not paid within a timely matter, never just rebill the claim. Take
the time to contact the insurance carrier to check on the status of the
claim. Most carriers allow you to check claim status online, but the
alternative is to call them.
All systems now should have a way to check how long a claim has
been outstanding. Your office insurance representative should follow up on all claims aged over 30 days.
To reiterate: Never simply re-bill a claim that has not been paid. Rebilling can lead to another denial for duplicate billing, or worse duplicate payment, which may subject your practice to fraud.
To avoid these common errors, take time to verify and input patient
information correctly, and check your procedure and diagnosis coding prior to billing. These basic steps will keep your revenue flowing.
Plus, its always easier to do it right the first time.
Judy A. Wilson, CPC, COC, CPCO, CPPM, CPC-P, CPB, CPC-I, CANPC, has been a medical
coder/biller for more than 35 years. For the past 25 years, she has been the business administrator for Anesthesia Specialists, a group of nine cardiac anesthesiologists who practice at
Sentara Heart Hospital. Wilson has served on the AAPC Chapter Association board of directors
since 2010. She is also on the board of directors of Bryant & Stratton College in Virginia Beach,
Va. Wilson is a PMCC instructor and teaches classes in the Tidewater area. She serves on the National Advisory
Board for American Academy of Billers for AMBA, has presented at several AAPC regional and national conferences, and is a member of the Chesapeake, Va., local chapter.
www.aapc.com
April 2016
27
CODING/BILLING
Slow down and take extra time to

verify and input patient information
correctly, and check your procedure
and diagnosis coding prior to billing.
CODING/BILLING
By David Zielske, MD, CIRCC, CCVTC, COC, CCC, CCS, RCC
CPT 2016:
Percutaneous Biliary Interventional Coding

Part 2: New codes change the way you should report these procedures.
or 2016, the biggest CPT coding changes affecting interventional radiology occur within the subspecialties of urinary, biliary, and
neurologic intervention. In March, we covered urinary intervention.
This month, well discuss the major changes in percutaneous biliary
interventional coding. Next month, well cover CPT updates for
percutaneous neurologic intervention.
Anatomically Speaking
it grows further, it may compromise additional ducts requiring three

or four catheters for successful drainage). Terminology for biliary
procedures refers to either catheters (which are externally accessible, such as an internal/external biliary drainage catheter) or stents
(which are not externally accessible, such as a metallic biliary stent).
New Codes for 2016
There are 14 new biliary intervention codes for 2016 (see New Biliary Intervention Codes for 2016 on page 29). These codes include
both the surgical and supervision and interpretation (S&I) components of the procedure. As well, all of the new codes bundle the use of
imaging guidance, including fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).
CPT guidelines instruct us to code separately for
each catheter placement, replacement, conversion,
Biliary obstruction at the
or removal. Catheter procedure codes are based on
distal common bile duct
each individual catheter via a separate access site.
Heres a rundown of how to apply the new codes.
The biliary system is divided into right- and left-sided bile ducts; however, these ducts divide further into multiple smaller branches that
may be individually accessed and drained, depending on the pathology treated (e.g., Klatskin tumor is a cholangiocarcinoma that has involved and caused bifurcation occlusions of the common bile duct. As
Cholangiography
Illustrations courtesy of ZHealth Publishing, LLC
28
Cholangiography (47532 and 47531) is performed to

evaluate the biliary system for patency, stones, strictures, malignancy, and leaks. These abnormalities
can occur anywhere in the collecting system, but
most often are between the ampullary sphincter of
the distal common bile duct and the bifurcation of
the more proximal common bile duct.
The cholangiogram may be performed via a new access (placing a needle or catheter through the right
side or anterior abdominal wall into the right or left
bile ducts respectively) or via a pre-existing catheter, usually an existing biliary catheter. Contrast is
injected and imaging is performed and interpreted. The procedure is reported with 47532 when
performed via a new access, or with 47531 when
performed via an existing access. Because imaging
guidance is performed, be sure the ultrasound, CT,
or MRI tech does not charge a guidance code when
the access uses one of these imaging guidance modalities.
Coding/Billing
Auditing/Compliance
Practice Management
Urinary
New Biliary Intervention Codes for 2016
Diagnostic cholangiography
CODING/BILLING
47531
Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access
47532 new access (eg, percutaneous transhepatic cholangiogram)
Percutaneous biliary drainage catheters

47533 Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external
47534 internal-external
47535 Conversion of external biliary drainage catheter to internal-external biliary drainage catheter,
percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg,
fluoroscopy), and all associated radiological supervision and interpretation
47536
Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external

to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
47537
Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
Percutaneous biliary stent placements

47538
Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each
stent; existing access
47539 new access, without placement of separate biliary drainage catheter

47540 new access, with placement of separate biliary drainage catheter (eg, external or internal-external)
Three add-on procedures:

cholangioplasty, biopsy, and stone extraction
+47542 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging
guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct
(List separately in addition to code for primary procedure)
+47543 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle),
including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure)
+47544 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging
guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
Access placement to assist with endoscopic biliary procedure

47541
Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary
procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when
performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access
Cholangiography is bundled with the new external biliary

catheter, internal/external catheter, and biliary stent placement
codes. The cholangiogram codes may be used as a base code
for +47542, +47543, and +47544, but only if a catheter is not
placed, replaced, or converted.
Example: A patient has an existing external biliary drainage
catheter. Diagnostic cholangiogram is performed (47531),
demonstrating a distal common bile duct stenosis. Cholangioplasty is performed (+47542). No tubes are left in place at the
end of the procedure.
The following codes involve placement of an external or internal/external biliary drainage catheter:
47533 describes the initial placement of a percutaneous
external biliary drainage catheter via a new access, and
includes diagnostic imaging 47532. Submit 47533 once
for each external biliary drainage catheter placed via a
new access at the same session.
47534 describes the initial placement of a percutaneous
internal/external biliary drainage catheter via a new
access, and includes diagnostic imaging 47532. Submit
47534 once for each internal/external biliary drainage
catheter placed via a new access at the same session.
47535 describes the conversion of an existing external
biliary drainage catheter to an internal/external catheter
(removal of the external catheter and placement of the
internal/external catheter over a wire, which requires
crossing of the distal common bile duct into the small
intestine), and includes diagnostic imaging. Submit
47535 once for each biliary catheter conversion at the
same session.
47536 describes the exchange of an existing external
biliary drainage catheter/external biliary drainage
catheter or exchange of an existing internal/external
catheter for a lesser external catheter, and includes
diagnostic imaging. Submit 47536 for each catheter
exchanged at the same session.
47537 describes the removal of an existing external or
internal/external biliary drainage catheter, and includes
diagnostic imaging. Submit 47537 once for each catheter
removed at the same session.
Example: The patient recently underwent external biliary
drainage catheter placement for biliary obstruction and inwww.aapc.com
April 2016
29
CODING/BILLING
Urinary
External biliary drainage
Internal/External biliary drainage

Illustrations courtesy of ZHealth Publishing, LLC
fection. Now that the infection

All three codes include
has subsided, a diagnostic cholan initial cholangiogram
angiogram is performed, show(47532, 47531) and all iming distal common bile stenoaging guidance (e.g., fluoTwelve biliary CPT codes were deleted for 2016 (47500, 47505, 47510, 47511, 47525, 47530,
sis. The external biliary catheroscopy, ultrasound, CT,
47630, 74305, 74320, 74327, 75980, and 75982), and five previously recommended endoter is removed over a wire and
MRI). Two stent codes can
scopic codes (47552, 47553, 47554, 47555, and 47556) should no longer be used for percutaan internal/external catheter is
be submitted when douneous procedures because new codes more accurately describe these procedures.
advanced with the distal tip in
ble-barrel, or side-by-side,
the small intestine and secured
stents are placed for the
in position (Add 47535 for the
treatment of a single stenosis
conversion of an external catheter to an internal/external catheter. (usually in the common bile duct from two approaches), when two
Do not report 47531, as its bundled with this conversion).
separate accesses are used to place two stents, and when two stents
are placed into two bile ducts for treatment of two separate stenoses. The stent codes may be used more than two times in individuInitial Biliary Stent Placements
There are three new codes for initial biliary stent placements. The als requiring multiple stents to treat multiple stenoses in different
ducts. If multiple overlapping stents are placed via a single access,
codes differentiate existing access from new access:
only one stent procedure code is submitted. Cholangioplasty is bun 47538 describes the placement of a completely internal stent
dled when performed at the same site as a biliary stent deployment.
(metallic or plastic) via an existing access (prior external
Example: A patient with an existing external biliary catheter presbiliary catheter or internal/external biliary catheter access)
ents
for conversion to an internalized metallic biliary stent (47538).
and includes exchange of an existing externally draining
At
the
end of the procedure, a new external biliary drainage cathebiliary catheter (if done); down-conversion to an external
ter
is
placed
over the guidewire due to excessive bleeding during the
catheter (when the original catheter is an internal/external
procedure
(This
is bundled with internal biliary stent placement.).
catheter); or removal of a catheter at the end of the procedure.
Deleted and Revised Biliary Codes
Do not submit 47536 or 47537 with this procedure.

47539 describes the placement of a completely internal stent
via a new access without leaving a biliary catheter at the end
of the procedure.
47540 describes the placement of a completely internal stent
via a new access with separate placement of an external or
internal/external biliary catheter. Do not submit 47533 or
47534 with this procedure.
30
New Code for Rendezvous Procedure

Code 47541 describes the creation of an access into the biliary system for subsequent use by an endoscopist. The radiologist will create a new access into a bile duct and advance a wire and small catheter across the biliary system and ampulla into the small intestine.
The catheter and wire are secured in position and sent to endoscopy,
where the gastroenterologist advances an endoscope into the duodenum, snares the wire, and uses this wire to advance a stent or bal-
To discuss this
www.aapc.com
Urinary
loon to complete that portion of the procedure. A cholangioplasty

or stent placement by the radiologist can be submitted separately.
If the radiologist leaves in a drainage catheter, 47533 or 47534
should be submitted instead of 47541. Do not submit 47541 when
a pre-existing catheter is accessed to perform the rendezvous procedure. When done via an existing access, submit a code describing
a catheter exchange, removal, or conversion (e.g., 47535-47537).
New Add-on Codes

Codes +47542, +47543, and +47544 require a base code, which can
be any of the catheter placement, conversion, or exchange codes, as
well as diagnostic cholangiogram codes 47532 and 47531.
+47542 describes cholangioplasty (balloon dilation) of any
bile duct for treatment of a stenosis or occlusion, and can also
be used to report balloon dilation of the ampullary sphincter
(sphincteroplasty) for subsequent stone extraction. Submit
+47542 once per treatment site, for a maximum of two sites
treated per session.
If more than two separate sites are treated with balloon dilation, no additional codes are submitted for the additional cholangioplasties. This may limit the number of cholangioplasties
submitted in patients with sclerosing cholangitis. This limitation does not apply to stent placements.
Cholangioplasty at the site of a stent placement during the
same session is bundled and not separately coded. Because of
add-on code edits, it may not be possible to submit +47542
with a biliary stent code (47538-47540), even when done in
different ducts. Do not use this code when a balloon catheter
is used for stone extraction.
+47543 describes an endoluminal biopsy (brush, needle,
or alligator forceps) of the biliary ductal system (common
bile duct, intrahepatic bile ducts). If multiple bile ducts are
biopsied, do not report additional procedure codes because
all ducts biopsied are described by using this single code.
Submit +47543 only once per date of service.
+47544 describes percutaneous biliary stone extraction by
any method, and includes removal of stone(s) with a basket
and/or pushed through the ampulla with a balloon. Do not
use this code for removal of debris or sludge, and do not use
CODING/BILLING
With the new codes added in 2016, a comprehensive

set of biliary codes is now available to describe almost
every procedure performed in the biliary system.
it with an attempted procedure modifier if stone retrieval is

attempted, but no stones are identified. Use this code only
once per session.
A catheter placement, replacement, conversion, or removal code
can additionally be submitted if done. An imaging code (47531 or
47532) can be submitted instead if the above catheter codes are not
performed. Code +47544 may be used for stone extraction from the
gall bladder via a cholecystostomy tube.
The three add-on procedure codes vary in the number of times each
code can be submitted per day, and depend on access sites/approaches, location, and extent of the lesions treated and the specific limitations on the codes submitted.
Example: The patient has an internal/external catheter in place via
a left anterior duct approach. The patient has a known filling defect
in the region of the distal common bile duct, and is here for biopsy.
The catheter is removed over a guidewire and a sheath is placed up
to the abnormality. A brush biopsy followed by alligator forceps biopsy are performed and sent for pathology (+47543). A new internal/external stent is placed over the wire (exchange of biliary drainage catheter, 47536).
Same Old Code May Be Used with New Codes

Percutaneous cholecystostomy, which includes placement of a
drainage catheter into the gallbladder (47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter
placement, cholecystogram when performed, and radiological supervision and interpretation), remains unchanged in 2016. This procedure may be reported with new codes for tube check (47531),
tube change (47536), tube removal (47537), and stone extraction
(47544).
With the new codes added in 2016, a comprehensive set of biliary
codes is now available to describe almost every procedure performed
in the biliary system. The opportunity for coding specificity has
never been better.
David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC, or 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 20052009, and is a member of the Nashville, Tenn., local chapter.
www.aapc.com
April 2016
31
CODING/BILLING
By Leonta (Lee) Williams, RHIT, CPC, CPCO, CCS, CCDS
MS-DRG May Spell TROUBLE

for Mechanical Ventilation Billing
CMS is looking for time to support billed services.
For billing, compliance, and reimbursement purposes, document the procedure appropriately, with
the dates and time (in hours) of when the mechanical ventilation began and when it concluded. To
calculate the number of hours of continuous mechanical ventilation by ET intubation during a hospitalization, begin counting from the start of intubation; the clock stops after weaning, extubation,
or patient discharge/transfer. When a patient presents to the hospital already intubated, counting begins when the patient is admitted.
mechanical ventilator is a device used to perform artificial respiration on a patient whose natural ability to breathe is compromised. Mechanical ventilation may be ordered for various reasons,
but it is generally used to get air into lungs, expel carbon dioxide from
lungs, or breathe for someone who cant do it on their own. Mechanical ventilation may also be used to help someone short of breath due
to a chronic lung disease. Invasive mechanical ventilation usually accomplished by endotracheal (ET) intubation or an artificial airway, such as a tracheostomy may be reasonable and necessary when
there are clinical indicators or lab values confirming the patient cannot maintain adequate ventilation.
Remember these key points when

reporting mechanical ventilation:
Calculate the duration of time in hours, not days.
Weaning time should be included in the calculation of total billable time.
The billable time for patients arriving to the hospital on ventilation begins when the
patient is admitted.
Time stops once the patient is extubated or transferred/discharged.
Ventilation support provided during a surgical procedure may be considered integral to the
procedure and not separately coded.
Ventilation support for an extended period following surgery may be coded if there is supporting provider documentation as to why the service is medically necessary.
32
Documentation Must
Support DRG Assignment
The 2016 Office of Inspector General (OIG) Work Plan includes review of Medicare payments for inpatient claims where the use of a
ventilator was billed. There is a difference in Medicare Severity-Diagnosis Related Group (MS-DRG) assignment and payment based
on the procedure code billed. An OIG audit for 2009-2011, with a
length of stay of four days or less, discovered an error rate of greater
than 95 percent in mechanical ventilation billing to Medicare. A total of 377 claims were reviewed and 363 of those claims showed an
overpayment.
To prevent overpayments, hospitals should have an internal audit system to monitor this service and validate the MS-DRG assignment. In
performing an internal audit, look for supporting documentation in
the medical record such as physician orders, nursing notes, respiratory therapy notes, operative notes, and provider progress notes.
In ICD-9-CM, the procedural codes identifying continuous invasive mechanical ventilation are 96.70 Continuous Invasive Mechanical Ventilation of Unspecified Duration; 96.71 Continuous Invasive
Mechanical Ventilation for Less than 96 Consecutive Hours; and 96.72
Continuous Invasive Mechanical Ventilation For 96 Consecutive Hours
Or More.
ICD-10-PCS requires you to be more specific:
5A1935Z Respiratory Ventilation, Less than 24 Consecutive Hours
5A1945Z Respiratory Ventilation, 24-96 Consecutive Hours
5A1955Z Respiratory Ventilation, Greater than 96 Consecutive Hours
Coding/Billing
Auditing/Compliance
Practice Management
istock.com/PaulVinten
Look at the Time
To discuss this
www.aapc.com
MS-DRG
The Centers for Medicare & Medicaid Services (CMS) revised the
language for several MS-DRGs related to respiratory ventilation to
reflect the title change of Greater than 96 Consecutive Hours. For
example:
MS-DRG 870
Septicemia or Severe Sepsis with Mechanical Ventilation 96+ Hours
MS-DRG 871
Septicemia or Severe Sepsis without Mechanical Ventilation 96+ Hours with MCC
MS-DRG 872
Septicemia or Severe Sepsis without Mechanical Ventilation 96+ Hours without MCC
The message here is to make sure clinicians are documenting start

and stop times, as well as supporting diagnoses.
CODING/BILLING
Look for supporting documentation in the medical record

such as physician orders, nursing notes, respiratory therapy
notes, operative notes, and provider progress notes.
Resources
Merck Manual, Overview of Mechanical Ventilation, Jesse B. Hall, MD, and
Pamela J. McShane, MD
2016 OIG Work Plan: https://oig.hhs.gov/reports-and-publications/workplan
OIG, Medicare Payments for Inpatient Claims with Mechanical Ventilation (A-09-12-02066)
AHA Coding Clinic. 2015. Update on AHA Coding Clinic for ICD-10-CM and ICD-10-PCS Part I
CMS, ICD-10-CM and ICD-10-PCS MS-DRG Definitions Manual: www.cms.gov/
ICD10Manual/version33-fullcode-cms/fullcode_cms/P0001.html
Lee Williams, RHIT, CPC, CPCO, CCS, CCDS, has over 13 years of health information management experience as a coding director, educator, trainer, and practice manager. She is the founder and past president of the Covington, Ga., local chapter and serves on AAPCs National Advisory Board, representing Region 4.
Be with the family and

earn CEUs!
Need CEUs to renew your CPC? Stay
in town. At home. Use our CD courses
anywhere, any time, any place. You wont have to

travel, and you can even work at home.
Our coding courses with AAPC CEUs:
The Wheres and Whens of ICD-10 (16 CEUs)

Dive Into ICD-10 (18 CEUs)
E/M from A to Z (18 CEUs)
Primary Care Primer (18 CEUs)
E/M Chart Auditing & Coding (16 CEUs)
Demystifying the Modifiers (16 CEUs)
Medical Coding Strategies: CPT Oview (15 Cs)
Walking Through the ASC Codes (15 CEUs)
Coding with Heart Cardiology (12 CEUs)
HealthcareBusinessOffice LLC: Toll free 800-515-3235

Email: info@HealthcareBusinessOffice.com
Web site: www.HealthcareBusinessOffice.com
From the leading provider of computer-based

interactive CD courses with preapproved CEUs
Take it at your own speed, quickly or leisurely
Just 1 course can earn as many as 18.0 CEUs
Apple Mac support with our Cloud-CD option
Windows support with CD-ROM or Cloud-CD
Cloud-CD lower cost, immediate Web access
Addl user licenses great value for groups
Finish a CD in a couple of sittings, or take it a

chapter a day you choose. So visit our Web site
to learn more about CEUs, the convenient way!
(All courses with

AAPC CEUs
also earn CEUs
with AHIMA.
See our Web site.)
Check out our website for our newest course,

The Wheres and Whens of ICD-10!
Continuing education. Any time. Any place.
www.aapc.com
April 2016
33
2017 CODE BOOKS ARE HERE!
VIEW OUR NEW LOOK
?
FIRST BOOK SHIPS FREE
WITH COUPON CODE SHIPSFREE

800-626-2633 | www.aapc.com/medical-coding-books
CODING/BILLING
By Mary Pat Whaley, FACMPE, CPC
Balance Billing:
Is It Legal?
Stay in line with private carrier
rules and follow updated
Medicare and Medicaid guidance.
alance billing is charging the patient for any balance on their account
after insurance has paid its portion. The question on everyones mind
is: Does the patient truly owe the balance after insurance pays?
The simple answer is, if there is a contract between the insurance plan and
the physician practice, the practice may collect up front from the patient:
Co-pays
Co-insurance
Deductibles
Any amount due for services the plan does not cover
If there is no contract between the insurance plan and the physician practice, the practice is not limited in what they may bill the patient.
Of course, it isnt really that simple. Knowing when you can or cant balance bill takes a bit more explanation.
Coding/Billing
Auditing/Compliance
Practice Management
www.aapc.com
April 2016
35
CODING/BILLING
Balance Billing
When to Balance Bill, and When Not To

If a physician has a contract with an insurance plan and the contract states (hopefully, correctly) that the patient is not responsible for the deductible, co-pay, or co-insurance for a specific service,
then billing the patient is illegal.
Likewise, if a physician has a contract with an insurance plan and
has permissibly collected the deductible, co-pay, or co-insurance,
billing the patient for anything above the allowable rate is illegal.
For Medicaid providers, balance billing is legal:
If the physician does not have a contract with the insurance
plan.
If the services are non-covered services (think cosmetic
surgery) by the insurance plan.
If the patient chooses to opt-out of using their insurance
and be a self-pay patient for any particular service.
Heres the rub: Sometimes (actually, many times) the insurance
company is not right. It fails to pay for things that should be paid,
Balance Billing Terminology

Contracted plan: An agreement between an insurer and a physician stating the physician agrees to accept a specific dollar amount for each service, regardless of what the
physician actually charges for the service.
Allowable: The contracted amount the physician has agreed to accept as complete
payment for a service. The allowable is made up of the portion the insurance will pay
and the portion the patient must pay.
Write-off: The difference between the physicians charge and the allowable, which
may not be collected from either the insurance plan or the patient.
Accepting assignment: A physician who accepts assignment agrees to the insurance
plans allowable and write-off amounts.
Some people equate accepting assignment with being a participating physician, but a
physician can participate in Medicare and not accept assignment.
In-network: This originally meant the physician was contracted with a preferred provider organization (PPO), but now often means a physician is contracted with any plan.
This most often comes up when a patient is referred to an out-of-network provider
for services, or when a patient undergoes a surgery or procedure in a hospital that is
in-network, but the anesthesiologist, radiologist, pathologist, intensivist (critical care),
hospitalist, emergency room doctor, or neonatologist is not.
36
and informs the patient that they have no balance. That information may be confirmed by the insurance plan when the patient
calls, simply because the company is referencing its own information. Some reasons why an insurer might process the services incorrectly are:
There is a glitch in their system.
They will not pay until the patient provides information to
determine coordination of benefits.
The patients enrollment or COBRA information has not
caught up in the system.
They have incorrect information about the physicians
participation in the network.
Special Case: The Qualified Medicare Beneficiary

Medicare recently updated information related to balance billing
patients who are qualified Medicare beneficiaries (QMBs).The
QMB Program helps Medicare beneficiaries of modest means pay
all or some of Medicares cost sharing amounts (i.e., premiums, deductibles, and co-payments). To qualify, patients must be eligible
for Medicare and must meet certain income guidelines. The income guidelines change April 1 each year.
The QMB program provides:
Payment of Medicare Part A monthly premiums (when
applicable);
Payment of Medicare Part B monthly premiums and
annual deductible; and
Payment of co-insurance and deductible amounts for
services covered under both Medicare Parts A and B.
Note: Medigap premiums are not covered by the QMB.
Eligibility criteria for this program require:
The individual to be eligible for Medicare Part A insurance
(even if not currently enrolled); and
The monthly income to be at or below 100 percent of the
annual federal poverty level, which is issued annually by the
U.S. Department of Health and Human Services.
Note: Individuals who are eligible for Medicare Part A, but not
enrolled, may conditionally enroll in Medicare Part A at any time
To discuss this
www.aapc.com
Balance Billing
during the year, after which they may apply for QMB to cover the
cost of the Medicare Part A premium.
If a patient is eligible for the QMB program, purchasing additional Medigap coverage for Medicare premiums, deductibles, and/or
co-payments may be unnecessary. Review the benefits covered by
the Medigap policy to see if the plan covers services other than the
Medicare cost-sharing that may be useful to the patient.
QMB Provider Certification for Title 19

The QMB program pays the 20 percent Medicare Part B co-insurance if the service provider is certified as a Medicaid provider. Note, however, a provider may choose to treat only QMB patients and not all Medicaid recipients. The provider may also limit the QMB patients he or she sees. Providers have no obligation
to treat Medicaid patients, or anyone in particular (Im asked this
question a lot!).
Medicare Update on Balance Billing

According to MLN Matters SE1128 Revised, February 1, 2016:
Federal law bars Medicare providers from balance billing
a QMB beneficiary under any circumstances QMB
is a Medicaid program for Medicare beneficiaries that
exempts them from liability for Medicare cost sharing.
State Medicaid programs may pay providers for Medicare
deductibles, coinsurance and copayments. However,
as permitted by federal law, states can limit provider
reimbursement for Medicare cost sharing under certain
circumstances.
Medicare providers must accept the Medicare payment and
Medicaid payment (if any) as payment in full for services rendered to a QMB beneficiary. Medicare providers who violate
these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions. Despite federal law, erroneous balance billing of QMB individuals persists. Many QMBs are unaware of the balance billing guidelines (or concerned about undermining provider relationships) and want to pay the cost-sharing amounts.
CODING/BILLING
If a physician has a contract with an insurance plan and has

collected the deductible, co-pay, or co-insurance, billing the
patient for anything above the allowable rate is illegal.
How to Ensure Compliance with QMB
Providers who participate in original Medicare and Medicare Advantage Replacement Plans not just Medicaid participants
must follow balance-billing prohibitions.
QMBs retain balance billing protection when they receive care in
other states. QMBs cannot waive their QMB status and pay Medicare cost-sharing.
Find out how to file for monies that Medicaid pays for QMBs. Understand the processes you need to follow to request reimbursement for Medicare cost-sharing amounts if they are owed by your
state. To bill your state, you may need to complete a state provider
registration process and be entered into the state payment system.
Heres how to identify QMB patients in your patient population:
Learn what your states QMB card looks like.
Find out if your state system can be queried to identify
QMBs.
Contact the commercial Medicare plans you accept to learn
what their QMB card looks like.
Make sure your billing staff exempt QMB individuals from
Medicare cost-sharing billing and related collection efforts.
Mary Pat Whaley, FACMPE, CPC, has more than 30 years experience managing physician practices of all sizes and specialties in the private and public sectors. She is board certified in Medical Practice Management. Whaley draws 30K+ visitors to her website (managemypractice.com) monthly, and is a Healthcare LinkedIn Thought Leader with 275,000+
followers. She is the originator of Credit Card on File for medical practices. Whaleys mission
is to create sustainable financial viability for small independent physician practices. She is
a member of the Durham, N.C., local chapter.
Resources
Shots Health News, NPR, States Make Laws to Protect Patients from Hidden Medical Bills,
Michelle Andrews, July 15, 2015: www.npr.org/sections/health-shots/2015/07/15/422964973/
states-make-laws-to-protect-patients-from-hidden-medical-bills
MLN Matters SE1128 Revised, February 1, 2016: www.cms.gov/Outreach-and-Education/
Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se1128.pdf
www.aapc.com
April 2016
37
CODING/BILLING
By Heather Greene, MBA, RHIA, CPC, CPMA
The Ins and Outs of Inpatient Psychiatric

Facility Perspective Payment System
art of our responsibility as healthcare business professionals

is to understand the financial realities of healthcare delivery
and reimbursement. For those of us working in mental health, this
means learning the ins and outs of the Inpatient Psychiatric Facility Perspective Payment System (IPF PPS).
IPF PPS Background

In section 124 of the Balanced Budget Refinement Act (BBRA)
mandated the secretary of the U.S. Department of Health & Human Services (HHS) to develop a per diem PPS for inpatient hospital services furnished in psychiatric hospitals and psychiatric units.
The PPS had to:
Include an adequate patient classification system to reflect
the differences in patient resource use and costs among
psychiatric hospitals and psychiatric units;
Maintain budget neutrality; and
Permit the HHS secretary to require psychiatric hospitals
and psychiatric units to submit information necessary for
developing the PPS.
The HHS secretary was required to report to congress describing
the development of the PPS.
38
The new system applies to Medicare patients, and the Centers for
Medicare & Medicaid Services (CMS) decided to use the current
PPS for consistency; however, instead of using a diagnosis related
group (DRG) payment, the facilities would be paid per diem, using
adjustments to a federal per diem base amount. The adjustments
were derived using regression analysis to determine relevant factors
to predict patient resources. The payment adjustors include both
facility-specific and patient-specific adjustments.
The final IPF PPS was developed using regression analysis data
obtained from the 2002 cost report file and 2002 Medicare Provider Analysis and Review (MEDPAR) data for IPF stays. The effective date for implementing IPF PPS was for cost reporting periods beginning on or after January 1, 2005. The PPS was based
on the final federal per diem rate for Medicare patients and is updated yearly.
Formulating Base and Adjustment Rates

Each year, the base rate is set and then adjusted using several factors to formulate the calculated base rate for an individual facility.
For 2016, the federal per diem rate is $745.19. Providers who fail to
report quality data for fiscal year (FY) 2016 will receive a proposed
FY 2016 per diem rate of $730.56 (a 2 percent reduction).
Coding/Billing
Auditing/Compliance
Practice Management
istock.com/hoodesigns
Account for DRG and comorbidity

adjustments and ensure all active
medical treatments and diagnoses
are documented.
IPF PPS
Adjustment factor (ADJ) Payment for an individual patient is adjusted, due to certain
factors.
Inlier A time covered by the Medicare Severity-Diagnosis Related Group (MS-DRG)
payment period of a claim that includes fully paid days, coinsurance days, or days after
benefits have exhausted.
Outlier An additional payment made by Medicare for high-dollar claims, intended to
protect hospitals from large financial losses due to unusually expensive cases.
Comorbidity The presence of one or more additional disorders (or diseases) cooccurring with a primary disease or disorder, or the effect of such additional disorders
or diseases. The additional disorder may also be a behavioral or mental disorder.
Comorbidity ADJ Adjustment factor reimbursement based on a comorbidity category.
The IPF PPS is based on a federal per diem base rate

that includes both inpatient operating and capitalrelated costs (including routine and ancillary services), and excludes certain pass-through costs (i.e.,
bad debt and direct medical education). The base
rate also provides patient-level and facility-level adjustments including wage index, teaching adjustments, and an add-on for rural facilities.
The payment for an individual patient is further adjusted for factors such as the DRG classification,
age, length of stay, and the presence of specified comorbidities. Additional payments are provided for
cost outlier cases, and qualifying emergency department (ED) electroconvulsive therapy (ECT) treatments. The IPFs affected by the PPS are freestanding psychiatric facilities, distinct part psychiatric
units of acute care hospitals, and distinct part units
of critical access hospitals
Several factors may adjust the payment: The federal
wage index adjustment, which is applied to the labor
portion of the service, an add-on of 17 percent for
facilities in rural areas, and an adjustment made for
qualified teaching facilities of 0.515 percent.
CODING/BILLING
Abbreviations & Definitions
In Alaska and Hawaii, there are varying cost of living adjustment

factors. Alaska ranges from 1.23 to 1.25 percentage points, and Hawaii ranges from 1.119 to 1.25 percentage points.
Another adjustment of 1.31 for first day is given if the facility has
a qualified emergency room (ER). To qualify, the ER department
must be licensed, advertised, and staffed, and 33 percent of patients
sought urgent treatment for ER conditions. Finally, if the patient
receives an ECT, there is an adjustment of $320.19.
There are also patient-specific adjustment factors. Patients under
45 years of age receive an adjustment factor of 1.00. This increases by 0.01 every five years after age 45, until age 64. For ages 6569, the adjustment factor is 1.10; for ages 70-74, the adjustment is
1.13; for ages 75-79, the adjustment is 1.15; and for those who are
80 years old or older, the adjustment factor is 1.17.
There are 17 Medicare severity-diagnosis related group (MS-DRG)
categories that receive adjustment factors. For example, DRG 885
receives an adjustment factor of 1.00 and DRG 881 receives 0.99,
as shown in Table A on the preceding page.
Table A: There are 17 MS-DRG categories that receive adjustment factors.
Name of Specific DRG
DRG
Adjust
Degenerative nervous system disorders with MCC
056
1.05
Degenerative nervous system disorders without MCC
057
1.05
Nontraumatic stupor and coma with MCC
080
1.07
Nontraumatic stupor and coma without MCC
081
1.07
Operating room procedure with principal diagnoses of mental illness
876
1.22
Acute adjustment reaction and psychosocial dysfunction
880
1.05
Depressive neuroses
881
0.99
Neuroses except depressive
882
1.02
Disorders of personality and impulse control
883
1.02
Organic disturbances and mental retardation
884
1.03
Psychoses
885
1.00
Behavioral and developmental disorders
886
0.99
Other mental disorder diagnoses
884
0.92
Alcohol/Drug abuse or dependence, left against medical advice
894
0.97
Alcohol/Drug abuse or dependence with rehabilitation therapy
895
1.02
Alcohol/Drug abuse or dependence without rehabilitation therapy with MCC
896
0.88
Alcohol/Drug abuse or dependence without rehabilitation therapy without MCC
897
0.88
www.aapc.com
April 2016
39
CODING/BILLING
IPF PPS
How CCs and MCCs Change Payment

Many patients have comorbidities. For psychiatric facilities, some
of these will add an adjustment factor, as shown in Table B. This
is different from the Medicare hospital inpatient prospective payment system, where a complication or comorbidity (CC) or major
complication or comorbidity (MCC) would change the DRG, thus
changing the payment; rather, comorbid conditions that fall into a
comorbidity category add another adjustment factor.
The IPF PPS has 17 comorbidity categories, each containing codes
of comorbid conditions. Each comorbidity grouping will receive a
grouping-specific adjustment. The facility can receive a single comorbidity adjustment per comorbidity category; however, it can
also receive an adjustment for more than one comorbidity category per encounter.
Comorbidities are specific patient conditions that are secondary to
the patients principal diagnosis and that require treatment during
the stay. The diagnoses that relate to an earlier episode of care and
have no bearing on the current hospital stay are excluded and must
not be reported on the facilitys claim. According to the 2015 IPF
PPS final rule, comorbid conditions must exist at the time of admission or develop subsequently, and must affect the treatment received, length of stay, or both.
The physician of record must connect any conditions the patient
may have with the treatment during the encounter. These conditions, if treated, must be well documented throughout the chart.
Its not enough simply to list the name of a condition; there must
be documentation to support the conditions treatment or how the
condition is affecting the mental conditions therapeutic treatment.
Resources
CMS.gov Inpatient Psychiatric Facility PPS: www.cms.gov/Medicare/Medicare-Fee-forService-Payment/InpatientPsychFacilPPS/index.html
Tools and Worksheets: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
InpatientPsychFacilPPS/tools.html
IPF PPS Regulations and Notices: www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/InpatientPsychFacilPPS/IPF-PPS-Regulations-and-Notices.html
The Medicare Claims Processing Manual, chapter 3 - Inpatient Hospital Billing, section
190.5.2 Application of Code First: www.cms.gov/Regulations-and-Guidance/
Guidance/Manuals/downloads/clm104c03.pdf
40
Table B: The IPF PPS has 17 comorbidity categories, each with an adjustment factor.
Description of comorbidity
Adjustment factor
Developmental disabilities
1.04
Coagulation factor deficits
1.13
Tracheostomy
1.06
Renal failure, acute
1.11
Renal failure, chronic
1.11
Oncology treatment
1.07
Uncontrolled diabetes-mellitus with or without complications
1.05
Severe protein calorie malnutrition
1.13
Eating and conduct disorders
1.12
Infectious disease
1.07
Drug and/or alcohol induced mental disorders
1.03
Cardiac conditions
1.11
Gangrene
1.10
Chronic obstructive pulmonary disease
1.12
Artificial openings digestive and urinary
1.08
Severe musculoskeletal and connective tissue diseases
1.09
Poisoning
1.11
Comorbidity Adjustments
Another patient-specific adjustment factor relates to the length of
stay. A variable per diem adjustment factor depends on several things.
For example, day one depends on if your facility has a qualified ER.
If it does, the adjustment factor is 1.31; if not, the adjustment factor
is 1.19, as shown in Table C on the next page. The adjustments
recognize the higher cost incurred in the early days of a stay.
To discuss this
www.aapc.com
IPF PPS
Table C: Other adjustment factors include length of stay.
Variable Per Diem Adjustments
Day 1 Facility without a qualifying emergency department

Day 1 Facility with a qualifying emergency department
Day 2
1.12
Day 13
0.99
Day 3
1.08
Day 14
0.99
Day 4
1.05
Day 15
0.98
Day 5
1.04
Day 16
0.97
Day 6
1.02
Day 16
0.97
Day 7
1.01
Day 17
0.97
Day 8
1.01
Day 18
0.96
Day 9
1.00
Day 19
0.95
Day 10
1.00
Day 20
0.95
Day 11
0.99
Day 21
0.95
Day 12
0.99
After Day 21
0.92
Code First Rules

A significant concern arises when we have to follow the Code First
rule. The Medicare Claims Processing Manual, chapter 3 - Inpatient Hospital Billing, section 190.5.2: Application of Code First
(last updated October 30, 2015) has been pivotal in explaining the
Code First rule. The manual explains how CMS handles this rule,
and how to calculate your DRG adjustment factor when the patients condition results in a principal diagnosis that is the etiology
of the manifestation treated in the facility.
Diagnosis code F02.81 Dementia in other diseases classified elsewhere
with behavioral disturbance is designated as NOT ALLOWED AS
PRINCIPAL DX code.
The three-digit code F02 Dementia in other diseases classified elsewhere is designated a Code First diagnosis, indicating that all diagnosis codes that fall under the F02 category (codes F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance
and F02.81) must follow the Code First rule. The code F02 appears
in the ICD-10-CM, as follows:
CODING/BILLING
Its not enough simply to list the name of a condition;

there must be documentation to support the
conditions treatment or how the condition is affecting
the mental conditions therapeutic treatment.
Code first the underlying physiological condition, such as:
F02.80 Dementia in other diseases classified elsewhere
without behavioral disturbance
NOT ALLOWED AS PRINCIPAL DX
F02.81 Dementia in other diseases classified elsewhere with
behavioral disturbance
NOT ALLOWED AS PRINCIPAL DX
According to Code First requirements, the provider would code the
appropriate physical condition first: for example, G20 Parkinsons
disease as the principal diagnosis code and F02.81 as a secondary diagnosis or comorbidity code on the patient claim.
The purpose of this example is to demonstrate proper coding for
a Code First situation. In this case, the principal diagnosis groups
to one of the 15 DRGs, or 17 MS-DRGs, for which CMS pays an
adjustment. Had the diagnosis code grouped to a non-psychiatric
DRG/MS-DRG, the Pricer would search the first of the other diagnosis codes for a psychiatric code listed in the Code First list to assign a DRG adjustment.
Final note: All diagnostic and non-diagnostic outpatient services (excluding ambulance) provided one day immediately preceding the date of the admission are considered to be inpatient services and are included on the inpatient claim, unless the patient does
not have Medicare.
Documentation Is Key
As health information management or coding professionals, you
should work to educate practitioners and clinicians on required
documentation, so you can fully and accurately account for a patients DRG and comorbidity adjustments. You should ensure all
active medical treatment and diagnoses are captured in the medical
record documentation, and remind practitioners to connect clinical
dots to substantiate treatment patients receive.
Heather Greene, MBA, RHIA, CPC, CPMA, is assistant vice president of compliance and
process improvement for Haven Behavioral Healthcare, Inc. She has approximately 20 years
of experience in a variety of health information management roles. Greene performs coding
and documentation audits, physician education, and process improvement for the Haven Behavioral Health, Inc. psychiatric facilities. She is a member of the Florence, Ky., local chapter.
www.aapc.com
April 2016
41
AUDITING/COMPLIANCE
By Sue Miller
The Latest on HIPAA:

The Gun Check Rule
If you provide care for patients with mental
illness, understand the nuances of this final rule.
s of January 6, theres a new HIPAA final rule. Formally known as the Health
Insurance Portability and Accountability
Act (HIPAA) Privacy Rule and the National Instant Criminal Background Check System (NICS) final rule, its been nicknamed
the gun check rule. Effective February 5,
2016 this rule requires an FBI check to determine whether an individual who wants to
purchase a firearm from a federally licensed
vendor is diagnosed with mental illness.
Note: Parts of this article appeared in Litmos, an online blog:
www.litmos.com/blog/healthcare/latest-hipaa-final-rule.
If your organization is a covered entity that

cares for people with mental illness, you need
to understand the nuances of the new rule,
and be ready to report to the NICS when
necessary.
The HIPAA Privacy Rule has been added on
to at Section 512 Uses and disclosures for
which an authorization or opportunity to
agree or object is not required (k) Standard:
Uses and disclosures for specialized government functions, (7) National Instant Criminal Background Check System.
Per the revised rule:
If a covered entity orders involuntary
commitments or makes other
adjudications regarding an
individuals mental health, or that
serve as repositories of the relevant
data, they are permitted to use or
disclose the information needed for
NICS reporting of such individuals
either directly to the NICS or to a state
repository of NICS data.
If a covered healthcare entity also has
42
a role in the relevant mental health

adjudications or serves as a state
data repository, it now may disclose
the relevant information for NICS
reporting purposes under this new
permission, even if its not designated
as a HIPAA hybrid entity or required
by state law to report it.
It does not create an express permission
for covered entities to disclose to NICS
for reporting purposes the protected
health information of individuals who
are subject to state-only mental health
prohibitors.
If you are a covered entity that must report to
the NICS, the preamble states that you must
report the data elements the NICS needs to
create a record, plus there is more that youre
permitted to share with NICS. The elements
needed to create the NICS record are:
The individuals name
The individuals sex
The individuals date of birth
The Federal Mental Health Prohibitor

The federal mental health prohibitor makes
individuals ineligible to purchase a firearm
because they have been committed to a mental institution or adjudicated as a mental defective. Department of Justice regulations define these categories to include persons:
Who have been involuntarily
committed to a mental institution for
reasons such as mental illness or drug
use;
Have been found incompetent to stand
trial or not guilty by reason of insanity;
or
Otherwise have been determined

by a court, board, commission, or
other lawful authority to be a danger
to themselves or others or unable to
manage their own affairs as a result
of marked subnormal intelligence
or mental illness, incompetency,
condition, or disease.
The record documenting the
involuntary commitment or
adjudication
The entity from which the record
initiated (your business name)
Additional data you may send include the individuals:
Social Security number
State of residence
Height
Weight
Place of birth
Eye color
Hair color
Race
These additional elements will help authorities weed out false positives.
The new section in the HIPAA Privacy Rule
does not name any data elements outlined
above. This gives the covered entity the flexibility to report the data required and requested by the federal government and any
state requirements your state may have for
your area.
istock.com/SKapl
Sue Miller has a 10-page memorandum explaining the new HIPAA final
rule in depth. You may contact her at tmsam@aol.com or (978) 505-5660.
Coding/Billing
Auditing/Compliance
Practice Management
Be Our Guest
Thank You to Our HEALTHCON Exhibitors and Sponsors

PLATINUM
GOLD
SILVER
BRONZE
Alpha II, LLC

Altegra Health
American Health
Information Management
Association (AHIMA)
American Medical
Association
ArroHealth
Aviacode
Barcharts, Inc
BC Advantage
Career Step
CHRISTUS Health
Cigna HealthSpring
Codebusters
Coding Network, LLC
(THE)
CodingAID
Columbia Southern
University
CSI Healthcare IT
DecisionHealth
Elsevier
Evident
Excite Health Partners
F. A. Davis Company
Find-A-Code
Florida Hospital Medical
Group
FTI Connsulting Health
Solutions
Gables Insurance
Recovery, Inc.
GeBBS Healthcare
Solutions
HCA Physician Services
Group
HCTec
HCPro
Health Information
Associates
Healthicity
IMO-Intelligent Medical
Objects
ionHealthcare
Kelly Services, Inc.
KIWI-TEK
Langley Provider
Group
Libman Education
Litmos Healthcare
MAAP Healthcare
Matrix Medical Network
Maxim Health
Information Services
McGraw-Hill Education
MedKoder, LLC
Mid-Atlantic
Permanente Medical
Group
myTRICARE.com
NAMAS
Ohana Healthcare LLC
Optum360
Panacea | MedLearn
Publishing
Perry Johnson &
Associates
RCM Health Care
Services
Reimbursement
Management
Consultants, Inc
Surgicode LLC
The Coding Institute
The College of St.
Scholastica
Ultimate Medical
Academy
United Audit Systems,
Inc.
Wolters Kluwer
Zhealth Publishing, LLC
AUDITING/COMPLIANCE
By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA
2016 OIG Work Plan:

Part B Risk Areas
The Office of Inspector Generals (OIG) annual work plan for
2016 outlines significant new areas, as well as ongoing target areas,
on which the federal agency will focus its reviews and audits
of U.S. Department of Health and Human Services (HHS)
programs and operations this year.
Lets take a look at whats on the OIGs radar for Medicare
Part B providers. Similar to the approach we took with
Part A, published in Healthcare Business Monthly
last month, well review the new and revised focus
areas only.
insurance companies,
to identify potentially
wasteful spending.
NEW! Osteogenesis stimulators OIG will look at lumpsum purchase versus rental.
They will determine whether potential savings can be achieved by Medicare and its beneficiaries if osteogenesis stimulators are rented over a 13-month period, rather than acquired through a lumpsum purchase.
Medical Equipment and Supplies

Billing and Payments
Medical Equipment and

Supplies Policies and Practices
For medical equipment and supplies, the OIG is honing in on the
policies and practices of:
Power mobility devices lump-sum purchase versus rental
Competitive bidding for medical equipment items and
services mandatory post-award audit
OIG will determine the reasonableness of the Medicare fee schedule by comparing Medicare payments made for orthotic braces to the amounts paid by non-Medicare payers, such as private
44
Regarding billing and payments of medical equipment and supplies, the OIG is focusing on:
Power mobility devices supplier compliance
with payment requirements
Nebulizer machines and related drugs supplier
compliance with payment requirements
Effectiveness of system edits for diabetes testing
supplies to prevent inappropriate payments for
blood glucose test strips and lancets to multiple
suppliers
NEW! Orthotic braces OIG will review Medicare Part B payments for orthotic braces to determine whether durable medical
equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers claims were medically necessary and were supported in accordance with Medicare requirements. OIG makes clear that compliance with documentation requirements and utilization guidance outlined in the local coverage determinations (LCDs) issued by the DMEPOS Medicare administrative contractor will be
the focus of its analysis. DME suppliers should review published
Medicare guidance to ensure compliance.
NEW! Increased billing for ventilators OIG has noticed a significant increase in billing for ventilators (specifically, HCPCS
Coding/Billing
Auditing/Compliance
Practice Management
istock.com/macgyverhh
Put these OIG compliance efforts on a

high priority focus list for your provider.
Work Plan
Level II code E0464 Pressure support ventilator with volume control

mode, may include pressure control mode, used with non-invasive interface (e.g., mask). From 2013 to 2014, OIG reports a 127 percent
increase in allowed amounts for E0464. OIG believes that suppliers may be inappropriately providing/billing for ventilators for patients with non-life-threatening conditions, and not meeting the
medical necessity criteria for ventilators. The Medicare National
Coverage Determinations Manual, Section 280.1, stipulates that
ventilators are covered for the treatment of severe conditions associated with neuromuscular diseases, thoracic restrictive diseases,
and chronic respiratory failure consequent to chronic obstructive
pulmonary disease. Ventilators are not considered reasonable and
necessary when the patient has a condition for which the relevant
LCD indicates a continuous positive airway pressure or respiratory assist devices is appropriate. DME suppliers should review published LCD guidance to ensure compliance.
Medical Equipment and Supplies

Quality of Care and Safety
OIG is reviewing quality of care and safety measures for DME in
regards to:
Access to DME in competitive bidding areas
Other Providers Policies and Practices

For other providers policies and practices, the OIG is focusing on:
Ambulatory surgical centers (ASCs) payment system
End-stage renal disease facilities payment system for renal
dialysis services and drugs
NEW! ASC quality oversight OIG will review Medicares
quality oversight of ASCs. Previous OIG work found problems
with Medicares oversight system, including finding spans of five
or more years between certification surveys for some ASCs, poor
Centers for Medicare & Medicaid Services (CMS) oversight of
state survey agencies and ASC accreditors, and little public information on the quality of ASCs. CMS requires that ASCs become
Medicare certified by a state survey and certification agency or privately accredited to show they meet the conditions. Because certification is a condition of payment, payments to ASCs without
AUDITING/COMPLIANCE
Because this is a mere summary of the Part B

provider portion of the 2016 OIG Work Plan, you
are encouraged to review it in its entirety to
ensure applicable risk areas are well understood.
proper or current certification are deemed as overpayments. For

this reason, ASCs should verify compliance with state accreditation requirements.
Other Providers Billing and Payments

For other provider billing and payments, the OIG is targeting:
Ambulance services questionable billing, medical
necessity, and level of transport ASC anesthesia services;
payments for personally performed services
Chiropractic services Part B payments for non-covered
services
Chiropractic services portfolio report on Medicare Part B
payments
Imaging services payments for practice expenses
Selected independent clinical laboratory billing
requirements
Annual analysis of Medicare clinical laboratory payments
Physical therapists high use of outpatient physical therapy
services by independent therapists
Portable X-ray equipment supplier compliance with
transportation and set-up fee requirements
Sleep disorder clinics high use of sleep-testing procedures
(CPT 95810 Polysomnography; age 6 years or older, sleep
staging with 4 or more additional parameters of sleep, attended
by a technologist and 95811 Polysomnography; age 6 years or
older, sleep staging with 4 or more additional parameters of
sleep, with initiation of continuous positive airway pressure
therapy or bilevel ventilation, attended by a technologist)
Inpatient rehabilitation facility payment system
requirements
ASC versus hospital outpatient payments
NEW! Physicians referring/ordering Medicare services and
supplies OIG will review select Medicare services, supplies, and
DME referred/ordered by physicians and non-physician practitioners (NPPs) to determine whether the ordering provider was
a Medicare-enrolled physician or NPP. If the referring/ordering
www.aapc.com
April 2016
45
To discuss this
www.aapc.com
AUDITING/COMPLIANCE
Work Plan
physician or NPP is not eligible to order or refer, then the claims

are not compensable. You should internally validate that the ordering provider of services, supplies, and DME is currently enrolled.
A review of past claims is also recommended. If the ordering provider is not an eligible (Medicare enrolled) provider, the payments
associated with claims made pursuant to any order from such a
provider should be disclosed and refunded.
NEW! Anesthesia services non-covered services. OIG will review Medicare Part B claims for anesthesia services to determine
whether the patient had a related and covered Medicare service.
Medicare will not pay for items or services that are not reasonable
and necessary. Specifically, where the anesthesia procedure was related to the performance of a non-covered procedure, the anesthesia is non-covered, as well. Anesthesia providers should review past
claims for compliance, and voluntarily disclose and refund any inappropriate payments. Make necessary modification to policies
and procedures to ensure compliance.
NEW! Physician home visits reasonableness of services. OIG
will determine whether Medicare payments to physicians for evaluation and management (E/M) services performed in the home
were reasonable and made in accordance with Medicare requirements. Since January 2013, Medicare made $559 million in payments for physician home visits. Physicians are required to document the medical necessity of a home visit in lieu of an office or
outpatient visit. Providers should review past claims for compliance and voluntarily disclose and refund any inappropriate payments. Make necessary modification to policies and procedures
to ensure compliance.
NEW! Prolonged services reasonableness of services. OIG
will determine whether Medicare payments to physicians for prolonged E/M services were reasonable and made in accordance
with Medicare requirements. The necessity of prolonged services is considered by CMS to be rare and unusual. The Medicare
Claims Processing Manual, publication 100-04, chapter 12, section 30.6.15.1, includes requirements that must be met to bill a
prolonged E/M service. Providers should review past claims for
noncompliance and voluntarily disclose and refund any inappropriate payments.
NEW! Histocompatibility laboratories supplier compliance
with payment requirements. OIG will determine whether payments to histocompatibility laboratories were made in accordance
with Medicare requirements. From March 31, 2013, through September 30, 2014, histocompatibility laboratories reported $131
46
million in reimbursable costs. Histocompatibility laboratories

are reimbursed based on reasonable costs, which must be related
to the care of patients, as well as reasonable, necessary, and proper. Histocompatibility laboratories should review past claims and
cost reports for noncompliance and voluntarily disclose and refund any inappropriate payments. Histocompatibility laboratories should make necessary modification to policies and procedures to ensure compliance.
Get to Know the OIG Work Plan

Because this is a mere summary of the Part B provider portion of
the 2016 OIG Work Plan, you are encouraged to review it in its entirety to ensure applicable risk areas are well understood. For each
focus area affecting your provider, be certain to review appropriate
CMS interpretive guidance, LCDs, and any referenced regulatory
provisions cited in the OIG Work Plan to ensure you completely
understand and comply with CMS expectations, particularly with
respect to documentation content and coverage limitations.
Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of
AAPCs National Advisory Board, serves on AAPCs 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 experience in
healthcare coding and over 18 years as a forensic 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-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.
Resources
For details pertaining to ongoing reviews, which are listed in this article only by name,
or for details regarding risk areas associated with Part C, Part D, and Medicaid programs,
please refer to the 2016 OIG Work Plan: http://oig.hhs.gov/reports-and-publications/
archives/workplan/2016/oig-work-plan-2016.pdf.
Medicare National Coverage Determinations Manual, 280.1: www.cms.gov/
Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf
Medicare Claims Processing Manual, publication 100-04, chapter 12, 30.6.15.1: www.
cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
For details regarding coverage requirements for histocompatibility laboratories, see 42
CFR 413.9(a), (b), and (c)(3): www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/ClinicalLabFeeSched/downloads/413_9.pdf
For requirements pertaining to cost reporting, see 42 CFR 413.24(a), (c): www.gpo.
gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-title42-vol2-sec413-24.pdf
Smart Design.
Intelligent Auditing.
Customize, manage, train and simplify your audit process. We streamlined your
audit process by merging audit workow, management, and reporting
capabilities into one easy-to-use, web-based solution.
HEALTHICITY.COM/AUDITMANAGER
AUDITING/COMPLIANCE
By Lisa Jensen, MHBL, FACMPE, CPC
Rock the Mock Audit

paring, and presenting that information. With this knowledge
in hand, you can focus on resolving issues uncovered during the
mock audit.
How to Get Started

First, determine how many resources and how much time you can
expend on an audit. For example:
Is there someone who will be in charge and who is able to
keep the focus and energy moving towards the end goal?
Do you have access to the reports you need to identify your
audit target areas?
Are the providers on board with this idea? And will they
be open to the feedback, corrective actions, and results you
will find?
Asking yourself these questions will help you to anticipate and address obstacles you may encounter during the mock audit.
You also must know what you agreed to with your payers. Review
the websites and contracts of top payers to learn what each health
plan requires as part of its integrity program or claims review process. Take note of the time periods for records review, whether an
auditor is allowed to visit the practice site, and the frequency with
which auditing can occur for each plan.
Identify Risk Areas
Does the thought of an external audit keep you up at night? Well,

fear no more! By conducting mock or self audits, you can uncover potential issues before a regulator or payer does. During such an
audit, an outside consultant or staff within your company assumes
the role of enforcement officials and conducts the level of investigation that is anticipated from the regulator.
Mock audits prepare your practice or facility for an official audit
by walking you through the process of documentation requests,
which involves identifying the information you will be asked to
disclose and designating personnel responsible for gathering, pre48
With limited resources and dollars, youll need to define the scope
of the mock audit to your highest risk areas. Start by determining
if past risk areas have been resolved. If no issues rise to the top, use
resources such as benchmarking data and common error reports to
assess risk. Good resources are the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), Comprehensive Error Rate Testing, Medical Group Management Association (MGMA) survey data, specialty society member Web
tools, etc.
The OIGs top hits for auditing can be found in the OIG Work
Plan. Common targets of the OIG are:
Improper application of modifier 25 Significant, separately
identifiable evaluation and management service by the same
physician or other qualified health care professional on the
same day of the procedure or other service and modifier 59
Distinct procedural service;
Coding/Billing
Auditing/Compliance
Practice Management
istock.com/pbophotographer
Know how your practice would fare in a government audit.
Mock Audit
AUDITING/COMPLIANCE
Up-coding (especially relative to evaluation and

management (E/M) services);
Unbundling of global surgery; and
Overuse of diagnostics without supporting medical
necessity.
Compare your CPT and HCPCS Level II utilization data with
CMS data available on the Medicare Utilization for Part B web
page (www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trendsand-Reports/MedicareFeeforSvcPartsAB/MedicareUtilizationforPartB.html). For
example, open the 2014 Medicare Part B Physician/Supplier
National Data - Calendar Year Evaluation and Management
Codes by Specialty file. To use this data file, copy the Internal
Medicine utilization under Allowed Services for each E/M code
you are interested in reviewing onto a spreadsheet, as shown in
Chart A.
Chart A: CMS Internal Medicine 2014
CPT
Frequency
Percentage
99201
8,184
1%
99202
90,835
5%
99203
494,415
30%
99204
784,102
47%
99205
282,662
17%
Total
1,660,198
Next, calculate a percentage for each code. For example, divide the
frequency number that internal medicine physicians coded 99201
(8,184) by the total of new patient codes reported (1,660,198). The
result tells us that internal medicine physicians coded 99201 approximately 1 percent of the time when billing Medicare for a lowlevel, new patient office visit in 2014.
Chart B
Internal Medicine Bell Curve

47%
30%
17%
1%
99201
5%
99202
99203
99204
99205
www.aapc.com
April 2016
49
AUDITING/COMPLIANCE
Mock Audit
Generate a similar billing utilization report from your practice

management system. Follow the same procedure to calculate the
frequency use of each code in your practice. These percentages
can then be used to create a bell curve (as shown in Chart B). Although coding above, below, or at the national bell curve for your
specialty does not necessarily mean youre coding accurately (or
not), knowing how your personal bell curve stacks up offers a clue
to areas your coding may deserve a closer look.
To simplify this process, AAPC offers the E/M Utilization Benchmarking Tool (www.aapcps.com/resources/em_utilization.aspx). This tool
compares a physicians, or an entire practices, evaluation and
management (E/M) CPT code utilization to peers in the same
specialty. The distribution of utilization by code within each E/M
subcategory is benchmarked to the distribution of paid Medicare
claims for physicians in the same specialty, nationally.
Time to Audit
After you identify the areas, providers, and codes that should be
targeted, its time to conduct the audit. Pulling a sample of, for instance, 10 charts per provider or 10 percent of total targeted charts
may be a good way to start, and keep the workload manageable.
External consultants may have other recommendations based on
the total volume of your practice and the types of services you bill.
The coding should be consistent with the auditing tools provided by your Medicare carrier, private payers, and standard coding
auditing guidance, including those found in the CPT and ICD
codebooks.
Tip: AAPCs Healthicity medical auditing software provides two viable solutions for internal
auditing: Audit Manager is an all-in-one audit management solution that simplifies the
audit workflow and takes the guesswork out of the audit process; Audit Services enables
you to pool from our nationwide network of credentialed auditors to conduct medical
chart reviews, medical record and documentation review, and audit validation. For more
information, visit: www.aapc.com/audit-management-software.aspx.
Share the Results

Shortly after the review session, be sure each provider receives a report (in table format) summarizing your overall findings. For example, the report might show there were three instances in which
a service was billed as 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 prob50
For information on this years OIG Work Plan, check out 2016
OIG Work Plan: Part B Risk Areas on pages 44-46 of this issue of Healthcare Business Monthly and 2016 OIG Work Plan:
Part A Risk Areas on pages 44-46 of Marchs Healthcare Business Monthly.
lem focused examination; Straightforward medical decision making,
but documentation would have supported 99213 Office or other
outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. You should also
provide each physician with a copy of his or her charts with the reviewers comments.
If youre concerned that some providers may disregard the feedback, you can place a redacted summary for all providers to see.
In this summary, let each provider know which data represents
their results, but block out the others. They can see how they did
in comparison with their peers. Many find this sort of competition very motivating.
Make a Positive Change

Be sure you do something about the errors, inconsistencies, and
other issues you find. For example:
Do policies and procedures need to be updated or
corrected?
Are there areas where additional education may be needed?
Does your electronic health record template require some
refining or a complete overhaul?
The same people who conduct the audit should notify management of the actions needed to address areas of weakness. Management should determine procedures for correcting these errors.
These procedures may vary from payer to payer.
Overpayments may need to be refunded or corrected bills resubmitted. Although this may amount to waving a red flag in front
of the insurer, its usually better to come forward than to play the
game of wait and see. For significant errors, consult your healthcare attorney before acting on your findings.
Like preventive medicine, proactive internal reviews allow you to
correct over-coding before it causes overpayment, and to correct
under-coding before it turns into under-billing.
To discuss this
www.aapc.com
Mock Audit
Overcome Obstacles
If a physician refuses to adapt his or her coding and documentation patterns to ensure compliance with applicable regulations,
disciplinary action may be warranted.
A very real danger is that you will conduct the audit and identify
errors, but will have no support to correct them. Knowing there is
an issue that your practice has done nothing to correct can create
a huge liability risk. To gain support, make the process as fun as
possible. For example, you might create T-shirts, candy bar wrappers, and notes with sayings such as, I Rock the Mock, Be Audit You Can Be! Keep Calm and Audit On, or Dont Make Me
Use My Audit Voice.
AUDITING/COMPLIANCE
To gain support you might create T-shirts, candy bar wrappers, and
notes with sayings such as, I Rock the Mock, Be Audit You Can Be!
Keep Calm and Audit On, or Dont make me use my audit voice.
Lastly, remember that rules change and people change, so periodic

internal audits are necessary. Keep the audit process fresh and relevant, and do your best to identify risk areas before they become
real problems.
Lisa Jensen, MHBL, FACMPE, CPC, is the senior manager of external audit at Providence
Health Plans in Beaverton, Ore. She has a masters degree in Healthcare Business Leadership. Jensen has been a Certified Professional Coder (CPC) since 1996 and a Fellow in the
American College of Medical Practice Executives (FACMPE) since 2008. She is a member of
the Portland Columbia River, Ore., local chapter.
AAPC VIRTUAL WORKSHOPS NOW AVAILABLE!

Find a virtual workshop near you:
www.aapc.com/Workshops
AAPC's virtual workshops
gives you more of what
you need:
Up to 6 CEUs
4 hours of virtual presentation
Authored and presented by leading experts
In-depth information on critical topics
Workshop Features:
Interactive and hands-on exercises

with case studies
4-hours includes presentation and
skill-building practice
Access on-demand recording
800-626-2633 | aapc.com/workshops
www.aapc.com
April 2016
51
PRACTICE MANAGEMENT
By Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC
bout a year ago, a group of my coding friends and I

started an email string we called, A Little Humor.
We would like to share some of our discoveries (taken
from redacted provider documentation) with you, along
with our comments.
To that end I recommend to the daughter that they proceed
rectally to the emergency room. Make sure to back in to the ER.
Hand pain she is to keep her abdomen with orthopedics.
Her hand can go home with her, however.
She was milking a car at work. Is that 2 percent or low-gas milk?
Blood pressure 135/75 is the gold. Whats the silver and
bronze blood pressure (BP), I wonder?
Mother presents to ER with her 6-year-old for redness and
facial swelling. The child appeared normal, so the doctor asked,
In what context does he have these symptoms (e.g., what is the
child doing when symptoms appear). The mother answered,
When hes blowing up a balloon. No comment needed.
Patient was placed on the operating tablet. I guess you can use
tablets for more than just getting on Facebook.
Hypertension with diabetes. Her blood pressure is cold.
Wonder what warm BP would be?
She is stressed because he has invited another woman into
their home to help get her on her feet. This woman is sharing
the bed with them. I would be stressed, too!
Patient states that she will lose weight one day, when her
family stops cooking so much. If only it were that easy.
Her biggest complaint [is] she would like to have bacon in her
diet. You cant live without Bacon.
8 year old white male was at work around 9:30 a.m. when a
heavy metal piston device smashed his finger. I guess they start
working em early in some places.
52
istock.com/Igor Zakowski
The
Doctor
Said
What
When medical
situations get
serious, sometimes
the medical
record becomes
humorous.
Humor is mankinds greatest blessing.
Mark Twain
He went outside to attempt the fetus chickens. Feed. Feed the
chickens.
A teenage driver lost control throwing a banana out the
window. Thats what you get for littering, kids.
Pts trial of a small amount of alcohol each afternoon may not
be working well, according to her daughter. Maybe the dose
needs to be adjusted?
Male with an ax in his head. He states his wife did it because
he asked her if it was that time of the month. And yes, he
lived.
Many thanks to the team who shared their hillarious notes: Karen
Lavigne, CPC, CPMA, CRC; Marcelle Viator, CPC, CRC; Kristie Fissler, CPC, CPMA, COC, COSC; Brenda Stevens, CPC,
CPMA, CRC; Jen Bueddeman, CPC, CRC; Kelley Sorenson,
CPC; Dawn Catanese, CPC, COC, CRC; and Colette Bohon,
CPC, CRC.
Send in Your Funny Doctors Notes

Wed like to hear your funny stories. Submit your laughs to lori.cox@
aapcnab.com for possible inclusion in future editions of Healthcare
Business Monthly.
Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, is the coding team leader at MedKoder, and has
over 17 years experience in multiple areas of healthcare. She has been certified since 2002 and
is the Region 5 Representative for the AAPC NAB. Cox is the treasurer for the Quincy, Ill./Hannibal, Mo., local chapter.
Coding/Billing
Auditing/Compliance
Practice Management
Crack specialty coding with the American Medical

Associations 2016 CPT Coding Essentials seriesthe
perfect companion to your CPT Professional codebook
Strengthen your knowledge and simplify your research with the new 2016 CPT Coding Essentials series. This
six-book series includes illustrations and plain English descriptions for code selection in a CPR code-driven
format. Each book focuses on CSM reimbursement and medical necessity information.
This is the only specialty series that comes straight from the source of CPT codethe AMAand exclusively
provides the CPT Editorial Panels Guidelines instructions on ICD-10-CM documentation and coding.
AMA
Each CPT Coding Essentials title includes CPT code for surgeries, medicine and ancillary services, paired with:
Illustrations and plain English descriptions of the service represented by the code
Official, code-specific instructions and parenthetical information from the AMAs CPT Professional codebook
ICD-10-CM codes mapped by coding experts
RVUs, global periods and modifier payment rules
References to CMSs Pub 100 and the AMAs CPT Assistant newsletter
To learn more, visit amastore.com or call (800) 621.8335.
Series includes:
CPT Coding Essentials for Cardiology 2016

CPT Coding Essentials for General Surgery & Gastroenterology 2016
CPT Coding Essentials for Obstetrics and Gynecology 2016
CPT Coding Essentials for Ophthalmology 2016
CPT Coding Essentials for Orthopedics: Lower Extremities 2016
CPT Coding Essentials for Orthopedics: Upper Extremities And Spine 2016
PRACTICE MANAGEMENT
By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P
Work together to ensure CDI

is maximized in all practitioner
documentation.
54
Clinical documentation affects the entire revenue cycle. If a medical

note is not properly documented, a domino effect leads to inaccurate
coding, which affects billing and financial management of the practice. Poor documentation may also affect quality of patient care because all elements arent captured accurately or considered based on
a practitioners findings. Because of this, clinical documentation improvement (CDI) plays a key role across the spectrum of healthcare
business management.
Coding/Billing
Auditing/Compliance
Practice Management
shutterstock.com
The Nine Cs of
Clinical Documentation Improvement
CDI
1. Clarity
The doctor may be able to read his own handwriting, but if you cant
make it out, the documentation is worthless. It shouldnt be your responsibility to decipher something illegible or ambiguous, and risk
miscoding based on that interpretation. Providers who are still using pen and ink need to be enlightened to the 21st century, where
we have sophisticated electronic health record (EHR) templates.
Shockingly, some practitioners with EHRs are still in the habit of
preparing their notes manually and relying on a scanner to transmit
them; this should be discouraged while using technological resources should be encouraged.
2. Consistency
Medical notes must not contain any words or sentences that could
be interpreted as inconsistent with the diagnosis assessed or the procedure performed. Consistency of documentation is important not
only for coding accuracy, but also for compliance. Its easy to slip up
on this if close attention is not paid to the chronology of the patients
present illness and treatment. In the event of an external audit or a
payer request for supporting documentation, the documenter must
be able to back up a claim of medical necessity. Inconsistencies in the
encounter note diminish the preparers credibility.
3. Completeness
As we strive to capture the entire clinical picture of the patient, its
important for the physician to document all information pertinent
to the patients diagnosis, such as any current and recently discontinued medications and changes in condition status. For example:
If a patient is diagnosed with septic arthritis or bursitis, the
organism causing the sepsis should be documented.
If a patient returns with lower sugar readings a week after
diabetes was assessed as out of control, controlled diabetes
(reflected by the lower readings) should be documented for
the current encounter.
Hypoxia caused by respiratory failure should be documented
for accuracy of coding, as well as clarity of the illness severity.
If a lysis of adhesions was performed, what organs or
structures were released? If an acquired absence of an organ
is relevant to a physicians finding, it should be documented
and picked up by you.
It may not be sufficient to simply document status post surgery
because you may need to know whether a complication was actually post-procedural or caused by the surgery. Be sure to list any potentially related comorbid conditions. Key elements missing from
the clinical note disservice the coders and billers, as well as quality of care.
4. Cohesion
There are many different styles of clinical notes, but whether the
practitioner uses a SOAP, CHEDDAR*, or narrative format, the underlying document should outline the patients chief complaint and
other related subjective data, as well as objective data, and smoothly segue into the assessment of the patients condition and the course
of action the provider will pursue.
*SOAP stands for subjective, objective, assessment plan and
CHEDDAR stands for chief complaint, history of presenting
illness, examination, details, drugs and dosages, assessment, return
visit information or referral.
5. Coder Friendliness
Physicians sometimes document in terms only they understand. You
may need to learn quickly about what is documented; Internet researching often helps, but its not a cure-all. You and your physicians
should educate each other.
www.aapc.com
April 2016
55
PRACTICE MANAGEMENT
The fundamental basis for CDI is to improve the clinical note,

which contains information about the encounter such as the patients symptoms (i.e., the reason for the visit) and history of present
illness, data measured and recorded, examination observations, an
assessment, a definitive diagnosis, and a care management plan. A
clinical note may reflect a variety of services and formats, such as a
progress note compiled by a doctor or staff nurse during an encounter with a patient in the office or outpatient setting, a summary of
laboratory findings and recommendations, a radiological interpretation or report, and an operative note.
A clinical note is a like a snapshot. Physicians may see dozens of patients a day, and if the information isnt recorded in the progress note
or operative report, its probably lost for good. Will a physician really remember how many minutes he spent counseling a patient on
smoking cessation or what the specific dimensions of a skin wound
repair were if this information is not documented at the time of the
encounter? This accentuates one of the assertions of the coders
creed: If its not documented, it didnt happen.
To assess the quality of your providers clinical documentation, you
may want to refer to what I call the Nine Cs of CDI.
PRACTICE MANAGEMENT
CDI
For example, if an orthopedic surgeon treats an open fracture, he

can simply add the word open to his diagnosis, or at least document that a skin wound was caused by the fracture. If the treatment
was performed on the proximal humerus, the specific location (surgical neck, greater tuberosity, etc.) will help you to code more precisely, instead of selecting an unspecified code within this anatomic site. Physicians should also try to minimize the amount of unfamiliar abbreviations they enter into clinical notes.
riers can sometimes cause transcription of incorrect information,

such as 50 mg instead of 15 mg. With medical terms, you have
to be especially careful with spelling and pronunciation because
words may look and sound similar (e.g., hypertension vs. hypotension). Its important for all clinical staff, including medical assistants who act as data processors and transcriptionists, to be properly trained in CDI. This may require someone validating their work
before it gets submitted.
6. Concision
9. Credibility
Ideal documentation stays on point with the patients current problem and the reason for seeking medical care. Its not necessary to
enumerate (or copy and paste) the patients entire medical history
or medication regimen, or make statements in the note that have
no bearing on treatment of the condition being managed or a related procedure being performed. Despite extreme severity of certain comorbid illnesses that must remain a part of the patients record of active problems, a specialist does not need to reiterate conditions if they are not relevant to the encounter. Concise documentation speeds up the coding process because you arent bogged down
reading superfluous text.
Credibility is one of the most important facets of CDI. When coding for professional services, medical staff including on-site and
off-site coders cannot use working diagnoses to code actual
findings. Words such as question of, probable, or likely preceding a clinical diagnostic term negate that term because no actual diagnosis has been established. If the physician has determined
the actual diagnosis, he or she should not add words in the documentation that cast doubt on the finding.
During the dictation and transcription process, you must be careful with cloned documentation, which is boilerplate text lifted
(i.e., copied and pasted) from one patient visit to the next (or even
from one patient to another). Such habits are fraught with peril, especially if cloned text hasnt been proofread for parameters that can
vary from encounter to encounter or patient to patient.
As deemed necessary, subordinate data entry should be qualitycontrolled at a checkpoint before a claim is submitted. This checkpoint should primarily be the responsibility of the clinical staff because the workflow may completely bypass you if no major edits are
caught between the EHR and the billing pipeline.
7. Compartmentalization
Sometimes physicians will document everything they are supposed to, but in no particular order or pattern. This may cause you
to overlook information germane to accurate coding.
Most EHR packages provide medical practice staff with the capability to design sophisticated templates from which they can fill
in the details of their progress note in a timely, cost-effective manner. In the EHR, the most valuable feature of the compartmentalization process is the ability to standardize the location of any key
element within the note. This greatly eases validating a charge or
coding the note from scratch, saves time, and creates a much less
error-prone workflow.
For instance, if a patient is given an inhalation treatment or a vaccination, the details of this procedure (drug dosage, constituents,
etc.) can be entered into a field called Orders, and you will always
know to look there for this piece of data.
8. Cleanliness
A clinical note riddled with grammatical and typographical errors
lacks professionalism and can create repercussions down the revenue cycle, including the possibility of a payer audit. Language bar56
Will a physician really remember how

many minutes he spent counseling
a patient on smoking cessation or
what the specific dimensions of a skin
wound repair were if this information
is not documented at the time of the
encounter?
To discuss this
www.aapc.com
CDI
PRACTICE MANAGEMENT
CDI Is More Important than Ever

The clinical note is a legal document. Physicians, coders, billers
(and anyone else involved in healthcare) are touched by the clinical note. Its the source from which you abstract information to select optimal codes for reporting to payers. We all must work as a
team to ensure we are maximizing the CDI factor in all practitioner documentation. With ICD-10 now a reality, specificity of documentation is more important than ever, and more stringent governmental and payer regulations reflecting CDI are in our future.
Coders and clinical staff should convene periodically or as needed
to address CDI, reviewing general issues discussed here, as well as
those that are specialty-specific.
Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P, is an educational consultant and PMCC
instructor with Superbill Consulting Services, LLC. He is also a professional coder for Signature Healthcare, a health system covering much of southeastern Massachusetts. Camilleis
primary coding specialty is orthopedics. Camilleis is a member of the Cape Coders local
chapter, in Hyannis, Mass.
CDI Checklist for Clinicians

1. Make sure someone other than the
documentor can read every element in the
note.
2. Avoid any inconsistencies in a clinical note.
3. Capture all clinical information that may
affect patient care.
4. Use clear paragraph structure, where
sentences adhere together, so as not to
break the readers train of thought.
5. Strive to document in a coder-friendly
manner to the extent possible.
6. Cut to the chase. Dont document what

isnt relevant to the encounter.
7. Ease the validation process by
standardizing location of common key
elements.
8. Perform quality assurance checks to
find obvious errors and questionable
transcriptions in clinical notes.
9. Make sure the note is credible in all
respects.
www.aapc.com
April 2016
57
PRACTICE MANAGEMENT
By John Verhovshek, MA, CPC
What (Not) to Wear While Job Hunting

To play the role of a successful employee, you have to look the part.
ooking for work is hard enough: Dont hurt your chances with a
wardrobe that fails to make a good impression. Here are a few insights from individuals on the front lines, with the responsibility
to fill open positions within their organizations.
The consensus: Be neat, polished, professional, and not too flashy.
And remember: Youre never fully dressed without a smile.
Geanetta Agbona, CPC, CPC-I

Educator, CGS Medical Billing Service, Charlotte, N.C.
On any interview, strive to appear polished, accomplished, skilled,
and competent. Your attire should impel me to belive you are an
expert in your field.
Pam Brooks, MHA, CPC, COC, PCS

Coding manager, Wentworth-Douglass Hospital, N.H.
I always recommend a prospective employee check out the dress
code of the organization prior to any interviews. Whats deemed
appropriate attire in some parts of the country may not be so
appropriate in others never assume.
Aside from that, I recommend business attire:
For women: a dark skirt or dress trousers, light-colored
blouse, and jacket or cardigan.
For men: shirt and tie, jacket optional. No, to the golf shirt.
Being overdressed is better than being inappropriately dressed.
Never wear jeans, sneakers, sweatshirts, t-shirts, or anything too
short, tight, or revealing. Women should wear stockings and low
heels. Keep jewelry simple. You want the interviewer to see you,
and not be distracted by your outfit.
Most hospitals have rules about multiple tattoos, multiple piercings, unnatural colored hair, and overwhelming cologne. I once
had an asthma attack and had to usher a job candidate out of my
office because she had marinated herself in cologne earlier that day.
Rhonda Buckholtz, CPC, CPC-I, CPMA,

CENTC, CGSC, CPEDC, COBGC, CRC, CHPSE
Vice president strategic development, AAPC
Research the organization at which you are applying to learn their
standards. You dont want to out-dress the CEO, but you also want
58
Coding/Billing
Auditing/Compliance
Practice Management
To discuss this
www.aapc.com
Job Hunting
PRACTICE MANAGEMENT
The best thing you can wear is your smile;

show them that you want to be there.
to appear polished and professional. Your appearance weighs heavily

on first impressions. Clean, well-pressed clothes are a must. Dont wear
heavy scents or heavy makeup that will distract interviewers. The best
thing you can wear is your smile; show them that you want to be there.
MariaRita Genovese, CPC, PCS

Administrator, oncology revenue cycle,
Thomas Jefferson University, Philadelphia, Pa.
What to wear to an interview:
Clean, well-fit clothing nothing tight or clingy
Ladies: Wear a dress/skirt with a jacket or cardigan sweater, or a
pantsuit
Men: Wear a suit and tie. A cardigan sweater in place of a jacket is
acceptable.
Appropriate footwear: no sneakers, platform heels, or flip-flops
Stockings for ladies
Moderate makeup
Moderate jewelry nothing that jangles
No colognes or other fragrant products someone at the office
may be allergic
A smile
istock.com/Michalel Jung
Ellen Maura Wood, CPC, CMPE

Practice manager, Seacoast General Surgery, Dover, N.H.
No matter if youre dropping off your resume cold or going to an
interview, dress professionally. That means business attire. For a man:
blazer, tie, and pressed pants. For a woman: stockings (no open toe shoes
or flip flops), pressed pants or dress/skirt. Dresses and skirts shouldnt be
much above the knee. I look at fingernails, too. We work in the medical
field, so cleanliness is important. When I went to business school over
30 years ago, I learned something that always stuck with me: Clean and
polish your nails before an interview. Ive done it before every interview
Ive ever gone to.
I used to tell my daughters, even if they were just getting after-school
jobs, dress like you want the job!
John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.
www.aapc.com
April 2016
59
NEWLY CREDENTIALED MEMBERS

Magna Cum Laude
Ajomol Atlin, COC-A
Alecia Cartwright, CPC, CRC
Azaruddin Mahammad, CIC
Baswaraj Banjanagari, CIC
Jennifer Borsody, CPC-A
Jessa May Tanias, CPC-A
Joan Opleda Salvatus, CPC-A
Joseph Paul, CIC
Julia Haun, CPC
Jyothirmayee Gaddamedi, CPC-A, CIC
Lalitha devi Veeramsetti, CIC
Leigh Ann Mahjoobi, COC-A
Linabelle De Venecia, CPC-A
Lindsey Wheeler, CPC-A
Maria Orta, CPC-A
Mary Gannon-McMurry, CPC-A
Padmavathy Narayanan, CIC
Pradeep Kumar Gattlola, CIC
Pradeep Pagidimarri, CIC
Raja Shekar Devanaboina, CPC-A, CIC
Rajesh Kumar Natchimuthu, CPC, CIC
Rakesh Gaddam, CIC
Santhosh Reddy Mandadi, COC-A, CIC
Shiela Marie Ong, CPC-A
Sona Thirumoorthy, CIC
Suganya Subramanian, CIC
Swapna Marepally, CIC
Swathi Gaddam, CIC
Vikram Reddy, CIC
Vinay Kumar Daram, CIC
CPC
Aarti B Menghrajani, CPC
Abraham Grimas, CPC
Adam Walker, CPC
Africa Ware, CPC
Agnieszka Popowski, CPC
Aimee Haydel, CPC
Alex Gonzalez, CPC
Alfredo Nasiff Hadad, CPC
Alisa R Hillock, CPC
Alisha Eifert, CPC
Altrese Jacob, CPC
Alyson Merrill, CPC
Amber Meade, CPC
Amell M Solano, CPC
Ana Cruz, CPC
Anays Fundora, CPC
Andrea Checovich, CPC
Andrea Hochstatter, COC, CPC, CEDC
Anessa Marie Uberroth, CPC
Angela Barber, CPC
Angela Jean Hall, CPC
Angelique Rodriguez, CPC
Anna Melendez, CPC
Anuradha Lakshminarayanan, COC, CPC
Aramis Paz, CPC
Arathy Radhakrishnan, CPC
Arlene Padron Alfonso, CPC
Ashley Creel, CPC
Ashley Meyers, CPC
Ashok Reddy Marella, COC
Athena Parscal, CPC
Autumn Cope, CPC
Awilda Agosto, CPC
Barbara Helen Sweeney, CPC
60
Becky Quarry, CPC

Belinda Phelps, CPC
Belkis Diaz, CPC
Bernadine Bell, CPC
Birgit Otto, CPC, CPMA
Biswajita Lenka, CPC
Bree Safranski, CPC
Brenda Honeycutt, CPC
Brenda Keller, CPC
Brenda Nielsen, CPC
Brianna Guinn, CPC
Brittany Etheredge, CPC
Brooke Swindal, CPC
Carlos Trujillo, CPC
Carmen G Perez Fundora, CPC
Carolyn Booker-Cruz, CPC
Carrie M Hook, CPC
Cassandra J. Whitehead, CPC
Cassie Ihrke, CPC
Catherine Lynn Chidzik, CPC
Cecilia Harris, CPC
Cecilia Sosa, CPC
Celeste Sowder, CPC
Chaine Socorro, CPC
Chandrani Roy, CPC
Chanthini Kothakulamparambil Venugopalan, CPC
Chinh Nguyen, CPC
Christine M Leite, CPC
Christine Nguyen, CPC
Ciara Quarles, CPC
Cindy Carpenter, CPC
Constance Holte, CPC
Cornelia Wallace, CPC
Courtney Long, CPC
Cristina Garcia, CPC
Crystal Callahan, CPC
Crystal Ramos, CPC
Cynthia Berry, CPC
Cynthia R Brannock, CPC
Daidy Guanche, CPC
Dana Birt, CPC
Danielle Wilkinson, CPC
Davina Manson, CPC
Dawn Shaw, CPC
Dawn Zellner, CPC
Dayci Torres, CPC
Deanna Clunie, CPC
Deborah Barker, CPC
Dede Kelly, CPC
Denise Ehrensberger, CPC
Denise Gardenia Cruz, CPC
Diana Hang, CPC
Diana Mahalbasic, COC
Diana R Seymour, CPC
Diana Roque-Gamez, CPC
Donna Spurlock, CPC
Donna Tabernacki, CPC
Dustin Berg, CPC
Dwaain Straker, CPC
Ebony Fair, CPC
Ebony Jones, CPC
Elizabeth Alfaro, CPC
Elizeth Milagros Garcia, CPC
Emily Dillow, CPC
Emily Narvais, CPC
Erin Brockmeier, CPC
Erin Kay Cox, CPC
Erin Puett, CPC
Erin Reed, CPC
Euna Ball, CPC
Felicia Burton, CPC
Felicia M Cephus-Williams, COC, CPC,
CPC-I, CEMC, CGSC

Ginger Whitley, CPC
Hannah Gross, CPC
Harish T, CPC
Heather Boothe, CPC
Iliana Rojas, CPC
Jackie Anne Zupon, CPC
Jayanna Coleman, CPC
Jeanetta Hambrick, CPC
Jennifer Guffey, CPC
Jennifer Jarrard, COC, CPC
Jennifer Robbins, CPC
Jennifer Rose Huffman, CPC
Jessica Brown, CPC
Jessica Francis, CPC
Jody Tenold, CPC
Johna Popovich, CPC
Josephinemary Samuelasirvatham,
COC, CPC
Julia Nicole Duran, CPC
Julie Ann Bradley, CPC
Karen L Becraft, CPC
Karen Lynn Edgar, CPC
Karen Megge, CPC
Karen Ranero, CPC
Katherine Mallette, CPC
Kathleen Lyman, CPC
Kathryn Walter, CPC
Kathy Bates, CPC
Katie Campbell, CPC
Katrina Rieta, CPC
Keesha L Coram, COC, CPC, CRC
Keisha Martinez, CPC
Kelli Bearden, CPC
Kelli Kienker, CPC
Kelly Bronnenberg, CPC
Kelly Thrower, CPC
Kemi J Hubbard, CPC
Khristina Valdez, CPC
Kimberley Ramsey, CPC, CPB
Kimberly Mahany Dixon, CPC
Kimberly Porter, CPC
Kimberly Williams, CPC
Kristen Dennis, CPC
Kristin Birmingham, CPC
Kristina Marthaler, CPC
Kristina Martinez, CPC
Kristy Nickson, CPC
Labiba Alam, CPC
Lameka Michael, CPC
Lana Jean Groth, CPC
Latoya Calloway, CPC
Laura Cirilli, CPC
Laurie Robertson, CPC
Laxmibhavani Dharavathu, CPC
Leanna Manley, CPC
Lena Rae Ragland, CPC
Leslie Koehn-Fertel, CPC
Leticia L Gonzalez, CPC
Lina E Rivero, CPC
Linda Grimes, CPC, CPC-P, CPMA
Lisa Alonso, COC, CPC
Lisa G Palmer, CPC
Lisa K Wilson, CPC
Lisa Lash, CPC
Lisa M Cona, CPC
Lorenza Ortiz, CPC
Loretta Lee, COC
Lori Cronise, CPC
Lori Hillman, CPC
Lori Taggart, CPC
Lori Warren, CPC
Lorie Ann Fitzer, CPC
Lorretta Maria Dixon, CPC

Lucy Mitha, COC, CPC
Luz M Paras, CPC
Lynette Lara, CPC
Mandy Norris, CPC
Marcella Soto, CPC
Marcia Hernandez, CPC
Margaret Ann Wilson, CPC
Maria De Luna, CPC
Maria Eugenia Trujillo, CPC
Maria Lorena Angel, CPC
Maria Saura, CPC
Marianela Delgado Medina, CPC
Marielena Urquiola, CPC
Marla Vance, CPC
Marvette Sherell Smith, CPC
Mary Ashley Adkins, CPC
Mary Duke, CPC
Mary V Balentine, CPC
Masheena Larkin, CPC
Mayda Rodriguez, CPC
Mayon Marie Tahal, CPC
Meagan Peluso, CPC
Melisa Falcon Garcia, CPC
Melissa Leeds, CPC
Melissa A Cruz, CPC
Melissa F Young, CPC
Melissa Schave, CPC
Melodie Ortiz, CPC
Meredith Ray, CPC
Michelle Brewer, COC, CPC
Michelle Pena, CPC
Michelle Trotter, CPC
Mila Nazarenko, CPC
Mirtza Pi, CPC
Mohamed Fayiz Nalakath Kuttikattil, CPC
Monica D Henderson, CPC
Monica Trumpler, CPC
Nahed Ibrahim, CPC
Nanette Turner, CPC
Natasha Brown, CPC
Nora Nervar Balabarcon, CPC
Norma Francisco Bonus, CPC
Osleidys Perez, CPC
Patricia Clarke, CPC
PushpaLatha Subbiah, COC
Rachel Stone, COC, CPC
Rajat Kumar Yadav, CPC
Rajesh Nakka, COC
Randi Butcher, CPC
Ranney Romero, CPC
Rasathithecla Lucas, COC, CPC
Rashana I Smith, CPC
Regina Hollins, CPC
Renee Garrison, CPC
Rizelle Mauleon, CPC
Robert Warburton, CPC
Ronda Eden, COC, CPC
Roxana Perez, CPC
Ruthie joy Punay, CPC
Safal Chariyampadath, CPC, CPC-P
Samantha L Popella, CPC
Samantha Carlton, CPC
Samantha Ruiz, CPC
Santina Mayo, CPC
Santor LaRay Wayans, CPC
Sarah Leggitt Sones, CPC
Saranya Ganesan, COC, CPC
Shahid Mahmood, CPC
Shameka Houston, CPC
Shanmuga Nagarajan Chickannan, COC
Shannon McNamee, CPC
Sharon Winters, COC, CPC
Shashikumar Natarajan, COC, CPC

Sherry Ann Coates, CPC
Sheyla Reyes, CPC
ShiCoah Yarbrough, CPC
Shimeka Johnson, CPCO, CPC-P, CPB,
CPMA, CPPM
Sima Kaufman, CPC
Sindhuja Chalamalasetty, CPC
Sonja Winstead, CPC
Sonya Gee, CPC
Sravana Jyothi Vedurupaka, CPC
Srinivasan Arumugam, CPC
Stacie Watie, CPC
Stephanie Anderson, CPC
Stephanie Durboraw, CPC
Stephanie T Baumert, COC, CPC
Steve John Meyer, CPC
Subhashini Manohar, CPC
Suneethi Venkatesh, COC, CPC
Sureshgujjanapudi Gujjanapudi, CPC,
CPC-P
Susan Anding, CPC
Susan Smith, CPC
Susanne J Tuck, COC, CPC
Susanne Rancourt, COC, CPC
Sushma Bellaby, CPC, CPB
Susithra Somasundaram, COC, CPC
Suzanne Murphy, CPC
Tammy Ragsdale, CPC
Tammy Schmarkey, CPC
Tara Hamilton, CPC
Tasha Turner, CPC
Teneka Taylor, CPC
Teresa M Stenquist, CPC
Teresa Mercer, CPC
Teresa Soffa, CPC
Teri L Roath-Baum, CPC
Thiencuong Nguyen, CPC
Tiffany Asher, CPC
Tina Knospe, CPC
Tonya L Johnson, CPC
Tonya Millsap, COC
Tracy Y Riedl, CPC
Tramaine Lewis, CPC
Tsion Tesfaye, CPC
Uyen Hodgdon, CPC
Vicky Marie Bowen, CPC
Vudari Kalpana, CPC
Wanda J Russell, CPC
Wendy Bahaw, CPC
Yajaira D Vazquez, CPC
Yaneris Lopez, CPC
Yaney Curbelo, CPC
Yara Romain, CPC
Zia Ahmed, COC
Apprentice
Aalapati Anusha, COC-A
Abhilash S, CPC-A
Abhisha Surabhi, COC-A
Abigail Rich, CPC-A
Ablessin Johnson, CPC-A
Ache. Shravan, CPC-A
Ada Chin, CPC-A
Adam Gold, CPC-A
Adapa Deepak Kumar, CPC-A
Adele Ciruti, CPC-A
Adrianna Brinker, CPC-A
Adrianne Hughes, CPC-A
Adrienne Lozano, CPC-A

Adunola Ademiluyi, CPC-A
Afrah Abdulkareem, CPC-A
Afshan Shamim, CPC-A
Ahmed Al Saedi, CPC-A
Ahmed Unnisha Shaik, COC-A
Ahuva Sclair, COC-A
Aide Romero, CPC-A
Aiza Uy, CPC-A
Ajesh Jose, COC-A
Akash Jain, CPC-A
Akhila Addhu, COC-A
Akkamolla Santhosh Reddy, COC-A
Akshaya Ashok Kumar, CPC-A
Akshaya Penkar, CPC-A
Alan Willoughby, CPC-A
Alberto Alfonso, CPC-A
Alegria Edono Mallorca, CPC-A
Alejandra McClain, CPC-A
Alejandra Torres, CPC-A
Alessandra Bentley, CPC-A
Alex Walker, CPC-A
Alex Hoover, CPC-A
Alexa Banegas, CPC-A
Alexandra Mickiewicz, CPC-A
Alfie Acabo, CPC-A
Alfred Blas, CPC-A
Alice Li, CPC-A
Alice Mierzwa, CPC-A
Alicia Edwards, CPC-A
Alicia Gray, CPC-A
Alicia Scrip, CPC-A
Alicia Shevokas, CPC-A
Alisa Kolomenskaya, CPC-A
Alison Bryan, CPC-A
Alison McKinney, CPC-A
Alissa Rosario, CPC-A
Allyson Schulte, CPC-A
Alma VanWinkle, CPC-A
Alwen Alilaen Elevado II, CPC-A
Alyssa Woodward, COC-A
Alyxandria Guzman, CPC-A
Amali Auxilia, CPC-A
Amanda Casner, CPC-A
Amanda Conklin, CPC-A
Amanda Gutzmann, CPC-A
Amanda Loy, CPC-A
Amanda Lupfer, CPC-A
Amanda Raemhild, CPC-A
Amanda Smith, COC-A
Amarendra Nath Bai, COC-A
Amarjeet Singh, CPC-A
Amber Perez, CPC-A
Amber Todi, CPC-A
Amber Underwood, CPC-A
Amir Khan, CPC-A
Amit Kumar Shrivasta, CPC-A
Amy J Hull, CPC-A
Amy Keeney, COC-A
Amy Messacar, CPC-A
Amy Phillips, CPC-A
Amy Simon, CPC-A
Amy Speidel, CPC-A
Amy Trujillo, CPC-A
Anagha Bhusari, CPC-A
Andrea Boger, CPC-A
Andrea Dixon, CPC-A
Andrea Johnson, CPC-A
Andrew Bulgin, CPC-A
Anesha Spencer, CPC-A
Angela Banks, CPC-A
Angela Kaatz, CPC-A
Angela Zito, CPC-A
Angelica Macalalag, CPC-A
Angelina Mullins, CPC-A

Angelo Alpuerto Hernandez, CPC-A
Angie Sanders, CPC-A
Anil Kumar Boorgula, COC-A, CPC-A
Anil Kumar Boorgula, COC-A, CPC-A
Anil Shreedhar Shet, CPC-A
Anil Singh, CPC-A
Anita Anderson, CPC-A
Anitha H.K, CPC-A
Anjana K R, CPC-A
Anjana Seena, COC-A
Anna Barrios, CPC-A
Anna Lachance, CPC-A
Anna Shvedchenko, CPC-A
Anthony Campbell, CPC-A
Anthony Shepps, CPC-A
Anuja Lad, CPC-A
Anuradha Singh, COC-A
Anurag Anant Jadhav, CPC-A
Anurag Malik, CPC-A
Anurag Sharma, COC-A
Aparnanagaveni Vennapusapalli, CPC-A
Apoorva Srivastava, CPC-A
April Rojas, CPC-A
April Zabele, CPC-A
Archana Poola, CPC-A
Archival Sotto Nadal Jr, CPC-A
Ardith Charles-Harris, CPC-A, CGSC
Arelia Huff, CPC-A
Arjun Kumar, CPC-A
Arlene Santos, CPC-A
Arlhyn Aguirre, CPC-A
Arsha George, COC-A
Arti Singh, CPC-A
Arun Raju, COC-A
Arun T Raj, COC-A
Aruna Selvaraju, CPC-A
Ashita Patel, CPC-A
Ashlee Anderson, CPC-A
Ashlee Harover, CPC-A
Ashley Ischar, CPC-A
Ashley Marie Ambeau, CPC-A
Ashley Mekmorakoth, CPC-A
Ashley Michelle Culbreth, CPC-A
Ashley Nicole Riley, CPC-A
Ashley Pineda, CPC-A
Ashlyn Breanna Tanner, CPC-A
Astha Bhatnagar, CPC-A
Aswinkumar Swarnaraj, CPC-A
Athira Chelladwora Raj, CPC-A
Athira G, COC-A
Audra Clarke, CPC-A
Audrey Precious Raquinio, CPC-A
Austin Wentworth, CPC-A
Auyna Bethancourt, CPC-A
Azeemuddin Mohammed, CPC-A
Azharuddin Mohammed, COC-A
Balabhadra Misra, COC-A
Balaji Kathirvel, COC-A
Bandaru Chaithanya, COC-A
Banupriya Mohanam, CPC-A
Barb Dufresne, CPC-A
Barbara Blood, CPC-A
Barbara Young, CPC-A
Baskar Balaji, COC-A
Baskaran R, COC-A
Beeram Sampath Kiran, CPC-A
Belinda Mabry, CPC-A
Bellamkonda Naresh, CPC-A
Bency Mol, CPC-A
Beth Shaddock, CPC-A
Beverly Benito, CPC-A
Bhagirath Reddy Palla, COC-A
Bhagwant Singh, CPC-A

Bharath Devendhiran, CPC-A
Bhaskar Reddy M, COC-A
Bhavya Suren, COC-A
Bhoopal Reddy Katipally, COC-A
Bhulaxmi Garikapati, COC-A
Billie Persons, CPC-A
Bindhu Sundaram, CPC-A
Blanca Patricia Baker, CPC-A
Blerina Ducellari, CPC-A
Bobbili Sunil, CPC-A
Bonnie Wallace, CPC-A
Bonnie Yoder, CPC-A
Brandy Marten, CPC-A
Brandy Mills, CPC-A
Briana Gilbert, CPC-A
Bridget Ferland, CPC-A
Bridget Hrycek, CPC-A
Bridget Miller, CPC-A
Brie Patterson, CPC-A
Brighty Devakirubai, CPC-A
Brittany Howell-Blaszczyk, CPC-A
Brittany Wassell, CPC-A
Brittney Miller, CPC-A
Brittney Pritchett, CPC-A
Bryan Pfeiffer, CPC-A
Candi A. Anderson, CPC-A
Carine Kimon, CPC-A
Carla Martinez, CPC-A
Carlee Lugo, CPC-A
Carlie Scholer, COC-A
Carly Batzel, CPC-A
Carol Bagal, CPC-A
Carol Berry, CPC-A
Carol L Keyes, CPC-A
Carole Flagler, CPC-A
Casey Thavy, CPC-A
Cassandra Forsman, CPC-A
Cassey Hattaway, CPC-A
Cassie Anderson, CPC-A
Catherine Foster, CPC-A
Catherine Renteria, CPC-A
Cathy Halstensgaard, CPC-A
Celia Mendez, CPC-A
Chaitali Ambekar, CPC-A
Chandralekha Chinnakannu, COC-A
ChandraSekhar Raju, CPC-A
Chandrasekhar Singh, CPC-A
Charizze Anne Sauro, CPC-A
Charles Allender, CPC-A
Chelsea Thomas, CPC-A
Chenchaiah Ramisetti, COC-A
Cherish Scott, CPC-A
Cheryl Rockwell, CPC-A
Cheryl Tinsley Hayes, CPC-A
Chethana Gobbali Kumara, CPC-A
Cheyenne Jorgensen, CPC-A
Christina Coleman, CPC-A
Christina Fuller, CPC-A
Christina OMarrah, CPC-A
Christine Stello, CPC-A
Christopher Dukart, CPC-A
Cielo Marcelino Hipolito, CPC-A
Cindy Brister, CPC-A
Cindy Howard, CPC-A
Cindy McNamara, CPC-A
Clarence Alindogan Nicolas, CPC-A
Claudia Nogueira, CPC-A
Claudia Salcedo, CPC-A
Colby Ware, CPC-A
Colleen Blevins, CPC-A
Connie Jones, CPC-A
Connie-Diane Whalen, CPC-A
Courtney Dumais-Myers, CPC-A

Courtney Johnson, CPC-A
Crystal Marie Akins, CPC-A
Cynthia Ballard, CPC-P-A
Cynthia Cates, CPC-A
Cynthia Dawkins, CPC-A
Cynthia Rodriguez, CPC-A
Cynthia Schmied, CPC-A
D.Mukesh Kumar, CPC-A
Daisy Santiago, CPC-A
Damon W Cohoon, CPC-A
Danaize Garcia, CPC-A
Danavian Sims, CPC-A
Danelle Davis, CPC-A
Daniel Hunt, CPC-A
Daniel Salazar, CPC-A
Danielle Freeman, CPC-A
Danielle Stokman, CPC-A
Danyel Speaks, CPC-A
Dara Crookshank, CPC-A
Darlene A Delibro, CPC-A
Darshana Nagwenkar, CPC-A
David Hufham, CPC-A
David Jaime, CPC-A
David Jr Ruiz, CPC-A
Dawn Gabree, COC-A
Dawn Hubbard, CPC-A
Dawn Lynn Klyczek, CPC-A
Dawn Potter, CPC-A
Dayami Estrabao, CPC-A
Deanna Elizabeth Perry, CPC-A
Deanna K Iwen, CPC-A
DeAnna Lerschen, CPC-A
Deanna Marie Duquesne, CPC-A
Debbie Peck, CPC-A
Debbie Schreppel, CPC-A
Debi Metevia, CPC-A
Deborah Hanner, CPC-A
Debra Downham, CPC-A
Debra Grabowski, CPC-A
Debra McMahon, CPC-A
Debra Sargent, CPC-A
Debra Whittum, COC-A
Dee Hart, CPC-A
Deepa Narayanagowda, CPC-A
Deepak Saxena, CPC-A
Deepti Katyal, CPC-A
DeLisa Smith, CPC-A
Detra Parker, CPC-A
Dharmateja Pennada, COC-A
Diana Kim Hager, CPC-A
Diana Nicholson, CPC-A
Dianne Henson, CPC-A
Dianne Potochniak, CPC-A
Dilip Chaudhari, CPC-A
Dinah St. Victor, CPC-A
Divya Chollati, CPC-A
Divya Francis, CPC-A
Divya Manisi, CPC-A
Divya N, CPC-A
Divyabharathi Selvaraj, CPC-A
Dizon Winnifred, CPC-A
Dolly Flowers, CPC-A
Dongababu Bandaru, CPC-A
Donn Polson, CPC-A
Dr Poornima, COC-A
Durgadevi Ramalingam, CPC-A
Eddagotla Himan Kumar, CPC-A
Edna Louise Compton, CPC-A
Edward Masong Tenorio, CPC-A
Efstratia Eleftheriou, CPC-A
Einat Berkman, CPC-A
Elias Abelardo Bequer, CPC-A
Elizabeth Allison, CPC-A

Elizabeth Beardsley, CPC-A
Elizabeth Green, COC-A, CIRCC
Elizabeth Molina, CPC-A
Elizabeth Nash, CPC-A
Ellen R Beason, CPC-A
Ellyssa Norkin, CPC-A
Elvira E Lara, CPC-A
Emily Dunbar, CPC-A
Emily Robinson, CPC-A
Emily Russo, CPC-A
Eric Flores, CPC-A
Erika Joy Arrieta, CPC-A
Erika Lemieux, CPC-A
Erika Parsons, CPC-A
Erika Ravenscraft, CPC-A
Erin Coleman, CPC-A
Estrella Tapec, CPC-A
Eva Silegy, CPC-A
Evelina Krivtsova, CPC-A
Ezhildevi Mohanmari, CPC-A
Faith Yonzon Secula, CPC-A
Frennylyn Gambayan, CPC-A
G Shiva Shankari, CPC-A
Gabriell Johnson, CPC-A
Gail Gaul, CPC-A
Gary Neu, CPC-A
Gayathri Arya. K, COC-A
Gayatri Atikela, COC-A
Geetha K, COC-A
Genine Santiago Neo, CPC-A
Gentry Jackson, CPC-A
Gerardo Labra, CPC-A
Ghouse Mohammad, COC-A
Gilberto Alcocer III, CPC-A
Glenn Mark Najorra, CPC-A
Gleybis Martinez, CPC-A
Gouthami Rakasi, CPC-A
Govil Packia Muthu Pounraj, CPC-A
Gowtham Kumar Inaganti, COC-A
Gowthaman Inbaraj, CPC-A
Grace Lebeda, CPC-A
Graciela Flynn, CPC-A
Gretchen Stenson, CPC-A
Guohong Li Watkins, CPC-A
Hammurabi Kabbabe, CPC-A
Harendra Rai, COC-A
Harika Kotha, COC-A
Hayley Simmons, CPC-A
Heather Kocourek, CPC-A
Heather Sinkevitch, CPC-A
Heather Sweat, CPC-A
Hector Brea Jr., CPC-A
Heidi Nystrom, CPC-A
Heidi Ricks, CPC-A
Helyn Adams, CPC-A
Hemalatha Kovoori, COC-A
Hemalatha Lakkala, CPC-A
Hemlata Sharma, CPC-A
Heng Saely, CPC-A
Hepsibha Sanamula, CPC-A
Hilda Griffin, CPC-A
Holly P Nelson, CPC-A
Holly Rietscha, CPC-A
Hudson R Harris, CPC-A
Husnaara Shaikh, CPC-A
Ian, CPC-A
Imran Ahmed Khan, CPC-A
Imran Mohammed Shaik, COC-A
Inga Chandler, CPC-A
Ivette Cano, CPC-A
Ivy Grace Silvestre, CPC-A
Jacci AR, CPC-A
www.aapc.com
April 2016
61

Jacintha Clara Pinto, CPC-A
Jacob Camandona, CPC-A
Jacqueline Ang - Bigtas, CPC-A
Jaggarao Jalumuru, CPC-A
Jagruti Vyas, CPC-A
Jaime Lomax, CPC-A
Jakkena Purushottam, COC-A
Jalyn Ashley Branscum, CPC-A
Jama Dunn, CPC-A
Jamie Carney, CPC-A
Jamie Donnelly, CPC-A
Jamie Short, CPC-A
Jan Michael Saludar Barroga, CPC-A
Jana Aplin, CPC-A
Jane Gabriel, CPC-A
Jane Marie Tyler, CPC-A
Janet Hosterman, CPC-A
Janet Kemp, CPC-A
Janet Scheltema, CPC-A
Janet Steed, CPC-A
Janice Diesta Go, CPC-A
Janice Gentile, CPC-A
Janice Wong, CPC-A
Jankee Patel, CPC-A
Jansi Venkatesan, COC-A
Jason Carden, CPC-A
Jason Maddox, CPC-A
Jason Smith, CPC-A
Javaji Kartheek, CPC-A
Jayanthi Balumurali, CPC-A
Jayanthi Narasiman, CPC-A
Jayanti Kushwaha, CPC-A
Jazil VP, CPC-A
Jean Ruby, CPC-A
Jeff Schultz, CPC-A
Jennifer Holmes, CPC-A
Jennifer Huskey, CPC-A
Jennifer Lynn Prohoroff, CPC-A
Jennifer Miller, CPC-A
Jennifer Miskowsky, CPC-A
Jennifer Paige Golden, CPC-A
Jennifer Prince, CPC-A
Jennifer Rickards, CPC-A
Jennifer Sandau, CPC-A
Jennifer Slagle, CPC-A
Jennifer Ziesemer, CPC-A
Jenny Parkin, CPC-A
Jenny Wilson, CPC-A
Jerika Celine Matias, CPC-A
Jerin John, CPC-A
Jess Ayers, CPC-A
Jessica Gomez, CPC-A
Jessica Hamilton, CPC-A
Jessica Hernandez, CPC-A
Jessica Johnson, CPC-A
Jessica Nicole Litton, CPC-A
Jessica Reilly, CPC-A
Jessica Rentz, CPC-A
Jessica Schroeder, CPC-A
Jessica Short, CPC-A
Jessica Smith, CPC-A
Jessica Wilson, CPC-A
Jessy Ancy Varghese, CPC-A
Jestine Bugner, CPC-A
Jewel Abraham, CPC-A
Jiji Joboy, COC-A
Jill Keetch, CPC-A
Jill Kepner, CPC-A
Jill Maruska, CPC-A
Jincy George, CPC-A
Jitender Rawat, CPC-A
JLyn Carruth, CPC-A
Jo Nell Grover, COC-A
62
Joanna Chowaniec, CPC-A

Joanna Michell Alcasid, CPC-A
Joanna Ordonez, CPC-A
Jodi Bonham, CPC-A
Jodi Cihal, CPC-A
Joel Arun Kumar Rajarathinam, CPC-A
Joemar Maglalang, CPC-A
Johanna Luber, CPC-A
John Ivan Reyes Torres, CPC-A
Joseph DeLoreto, CPC-A
Joseph Garrett, CPC-A
Joseph Linson, CPC-A
Joseph Luigi Torres, CPC-A
Josie Fonua, CPC-A
Joy Wilson, CPC-A
Joyce Bowden, CPC-A
Joyce Piper, CPC-A
Juan Montanez, CPC-A
Judy Lyn McCue, CPC-A
Judy Zamora, CPC-A
Julia Keiser, CPC-A
Julia Keiser, CPC-A
Julia Stephenson, CPC-A, CPPM
Julie Ahrendt, CPC-A
Julie Dillon, CPC-A
Julie Hoffman, CPC-A
Julie Wieneke, CPC-A
Julie Wysner, CPC-A
Julissa Tuya, CPC-A
Jullianne Tanya Regencia, CPC-A
Justin Dipiazza, CPC-A
Justine Malecki, CPC-A
Jyothisree Vadlakonda, CPC-A
Jyoti Anand, CPC-A
Kabde Ankita, COC-A
Kaeylor Joseph, CPC-A
Kakarla Venkata Hemanth, COC-A
Kalpana Janagam, COC-A
Kalpana Kannan, CPC-A
Kamala Shaddock, CPC-A
Kara Flaugher, CPC-A
Karan Shinde, CPC-A
Karen Shewmaker, CPC-A
Karen Wisby, CPC-A
Kari A. Willingham, CPC-P-A
Karthik Katakam, COC-A
Karthik Nalla, COC-A
Karthik Raman, COC-A
Kassia Lynn Olszewski, CPC-A
Katherine Kreamer, CPC-A
Katherine Licerio, CPC-A
Kathleen Casey, CPC-A
Kathleen Murphy, CPC-A
Kathryn Arena, CPC-A
Kathy Hansen, CPC-A
Katie Hoffer, CPC-A
Katie Rebeca Sousan, CPC-A
Katrina Medina, CPC-A
Kavya Allam, CPC-A
Kay Johnson, CPC-A
Kayla DeMott, CPC-A
Kayla Herrera, CPC-A
Kayla Kerns, CPC-A
Kayla Rice, CPC-A
Kayla Sauls, CPC-A
Kayti Shipley, CPC-A
Kela Hamilton, CPC-A
Kelli Quilici, CPC-A
Kellie Wilson Phillips, COC-A
Kelly Benoit, CPC-A
Kelly Black, CPC-A
Kelly Buchanan, CPC-A
Kelly Heeg, CPC-A
Kelsi Mikel Brown, CPC-A

Kendra Quach, CPC-A
Keneath Anne Villarin, CPC-A
Kenneth Gary, CPC-A
Kenneth Jay Cabrito, CPC-A
Kerri Miller, CPC-A
Ketananandrao Jadhav, CPC-A
Kevin McFadden, CPC-A
Kevin Raj, CPC-A
Khadija Bowen, CPC-A
Khaleelur Rahman, CPC-A
Kim Johnson, CPC-A
Kim Lecus, CPC-A
Kim Piotrowicz, CPC-A
Kimberly Myers, CPC-A
Kimberly Aguirre, CPC-A, CPB
Kimberly Cooper, CPC-A
Kimberly Cotter, CPC-A
Kimberly Erickson, CPC-A
Kimberly Jones, CPC-A
Kimberly M Hamilton, CPC-A
Kimberly McLain, CPC-A
Kimberly Pence, CPC-A
Kimberly Wilson, CPC-A
Kira Hamill, CPC-A
Kirk Neal, CPC-A
Kolla Ravindar Reddy, CPC-A
Kompally Kiran, COC-A
Korina Solis, CPC-A
Kosgi Chandana, CPC-A
Kothanda Raman P B, COC-A
Krishnateja Kolusu, CPC-A
Krista De Kerillis, CPC-A
Kristalyn Thompson, CPC-A
Kristen Machen, CPC-A
Kristen ONeill, CPC-A
Kristen Orange, CPC-A
Kristina Louise Crowner, CPC-A
Kristina Richwine, CPC-A
Kristine Joyce Acosta, CPC-A
Kruti Dineshbhai Patel, CPC-A
Krystal L Libertucci, CPC-A
Kuldeep Singh, CPC-A
Kuppuswamy K, CPC-A
Kuril Rahul, COC-A
Kyla Keith, CPC-A
Kyle Deters, CPC-A
Laarnie Mallari, CPC-A
Lakshmanudu Bommana Boina, COC-A,
CPC-A
Lakshmisri Mariappan, CPC-A
Larry Walton, CPC-A
Laura Egloff-Slater, CPC-A
Laura Parrish, CPC-A
Laura Sinitsky, CPC-A
Lauren Bilbrey, CPC-A
Lauren Elizabeth Sherman, CPC-A
Laurice Joy Micmic, CPC-A
Laurie Bouzarelos, CPC-A
Laurie Burrell, CPC-A
Laurie Crawford, CPC-A
Lavanya Reddy Kandadi, COC-A
Laverne Howard, CPC-A
Laymar Lopez, CPC-A
Leah Dormitorio Peregrino, CPC-A
Leeah Harris, CPC-A
Leena Gogada, COC-A
Leenus Patrick Obed, CPC-A
Leiann Kinder, CPC-A
Leighanne Smith, CPC-A
Leonard Melgarejo, CPC-A
Leslee Colbert, CPC-A
Leslie A Knueppel, CPC-A
Leslie Alexander, CPC-A

Leslie Boyd, CPC-A
Leteia Ann Holt, CPC-A
Leydis Perez, CPC-A
Li Shao, CPC-A
Lillian Thayer, CPC-A
Lily Thakur, CPC-A
Limaris Perez, CPC-A
Lindleigh Wirth, CPC-A
Lindsey Adkins, CPC-A
Lindsey McKane, CPC-A
Lisa Arbeene, CPC-A
Lisa Duncan, CPC-A
Lisa Marie Wilson, CPC-A
Lisa Miller, CPC-A
Lisa Molnar, CPC-A
Lisa Pedicini, CPC-A
Lisa Tibbs, CPC-A
Liz Crociani, CPC-A
Liza Peaflorida, CPC-A
Lizeth M Cruz, CPC-A
Lori A Kahler, CPC-A
Lori Azzouz, CPC-A
Lori Pendleton, CPC-A
Loribeth Carbonell, CPC-A
Lorie Bryant, CPC-A
Louie Allam, CPC-A
Loukya Boppana, COC-A
Lovakumar Korumilli, COC-A
Love Brunson, CPC-A
Lucnol Jean-Pierre, CPC-A
Lynda Ross, CPC-A
Lynette Singh, CPC-A
Lynne Lanneau, CPC-A
Lynzee Ringeisen, CPC-A
M. Naga Saikiran, CPC-A
Ma. Ailyn Benz Nicolas, CPC-A
Ma. Dianne Zafe Reso, CPC-A
Ma. Lourdes Loyola Maglalang, CPC-A
Ma. Virginia Quinan, CPC-A
Machangar Akshitha, CPC-A
Macy Loden, CPC-A
Madelyn Aldridge, CPC-A
Madhu Keerthi Dhanalakota, COC-A
Madhura Walke, COC-A
Madhusmita Bhaisora, CPC-A
Magdalena Sandu, CPC-A
Magnolia T. Reyes, CPC-A
Mahendar Reddy G R, COC-A
Mahender Reddy Mechala, COC-A
Mahesh Boora, COC-A
Mahesh Jaya Poojari, COC-A
Mahesh Vavilala, COC-A
Majlinda Laska, COC-A
Maj-Maj Melendres, CPC-A
Malathi Durairaj, CPC-A
Malia Dyck, CPC-A
Malini Rishikesh, CPC-A
Mallorie Oneal, CPC-A
Mallory Pemberton, CPC-A
Mamatha Kalyani Yellagandula, COC-A
Mamatha Pulyala, COC-A
Manasa Devi Kancharla, CPC-A
Mangali Laxmaiah, COC-A
Manikanta Tirumala, COC-A
Manisha Pasupuleti, CPC-A
Marcela Marie Johnson, CPC-A
Marcy Smith, CPC-A
Margiemel Castro Adviento, CPC-A
Maria DiFiore, CPC-A
Maria Elishah Ruth Corpuz, CPC-A
Maria Martens, CPC-A
Mariam Thomas, CPC-A
Maridol Nina Mutia Taladua, CPC-A

Marie C Lillie, CPC-A
Mariela Manzanares, CPC-A
Marielle Lopez, CPC-A
Marion Isaiah Dimapilis Garcia, CPC-A
Marissa Lesky, CPC-A
Maritzabel Garcia, COC-A, CPC-A, CRC
Markondaiah Anthati, COC-A
Marlene Rogers, CPC-A
Marren Gilchrist, CPC-A
Mary Ann Jones, CPC-A
Mary Ann Kompinski, CPC-A
Mary Boyer, CPC-A
Mary C. Ward, CPC-A
Mary Catherine Keiper, CPC-A
Mary Davenport, CPC-A
Marye Minor, CPC-A
Matin Raje, CPC-A
Matta Sanjay Kumar, CPC-A
Matthew Garis, CPC-A
Maximilian Golec, CPC-A
Meenaben Mahida, CPC-A
Megan Fry, CPC-A
Megan Herrick, CPC-A
Megan Walter, CPC-A
Meghan Morris, CPC-A
Melissa Beller, CPC-A
Melissa Hottinger, CPC-A
Melissa Mackler, CPC-A
Melissa Neuharth, CPC-A
Melody Dawson, CPC-A
Melody Karamba, CPC-A
Meridith Roe Hall, CPC-A
Merrisa Hall, CPC-A
Michael Dexter Sy, CPC-A
Michele Calvin, CPC-A
Michele Payne, CPC-A
Michele Reinert, CPC-A
Michelle Chu, CPC-A
Michelle Dallaire, CPC-A
Michelle Norat, CPC-A
Michelle Sartelle, CPC-A
Michelle Zuniga, CPC-A
Mickey (Warren) McCandless, CPC-A
Misty Yandell, CPC-A
Moganapriya Prakash, CPC-A
Mohammad Imran Baig, CPC-A
Mohammed Chand Basha, COC-A
Mohan, CPC-A
Mohana Rajendran, CPC-A
Mohsina Hassan, COC-A
Mona Bedros, CPC-A
Monica Smith, CPC-A
Monika Shivaji Mane, CPC-A
Monisha Chand, CPC-A
Morgan Dodson, CPC-A
Moyah Hardin, CPC-A
Mrignalini Ranjan, CPC-A
Muppirisetty Balaji, CPC-A
Muthumari Durga Nachiyappan, CPC-A
Muthuselvi Gurusamy, COC-A
Mylinda Hawks, CPC-A
N. Madhury, CPC-A
N.B. Lakshmi Priya, CPC-A
Nadya Soho, CPC-A
Naga Jyothi Swarna, CPC-A
Nagalakshmi Yandamuri, CPC-A
Nagaraju Arroju, COC-A
Nagaraju Mamidi, COC-A
Nagarjun V, COC-A
Nagavel Suresh, CPC-A
Nakicia Turner, CPC-A
Nakisha Murry Gordon, CPC-A

Nallavelly Smitha Varma, COC-A
Nancy G Fernandez, CPC-A
Nancy Ma, CPC-A
Nancy Prabha, COC-A
Nancy Ryan, CPC-A
Nandhakumar P, COC-A
Naresh Krishna Pattapu, COC-A
Naresh Kumar, CPC-A
Naresh Nukala, COC-A
Natalia Jessica Javier, CPC-A
Natalie Anderson, CPC-A
Natalie Savage, CPC-A
Natalie Toth, CPC-A
Nataraj M, CPC-A
Naveen Chinnam, COC-A
Naveen kumar Manchala, COC-A
Naveen Manga, COC-A
Naveen Mokide, CPC-A
Naveena Josephin, COC-A
Nazima Anwar Khan, CPC-A
Neha Parte, CPC-A
Neil Radovan, CPC-A
Nelaine Grace Tan, CPC-A
Nelissa Anne Flojo, CPC-A
Ness-Lee Guerrero, CPC-A
Nethula Sravani, CPC-A
Nick Fenn, CPC-A
Nicole Fuller, CPC-A
Nicole M Fuentes, CPC-A
Nicole Parrish, CPC-A
Nicole R Nichols, CPC-A
Nicole Robinson, CPC-A
Nicole Williams, CPC-A
Nigam Gupta, COC-A
Nikhil Prabhakar Patil, CPC-A
Nikitagangaram Palkar, CPC-A
Nila Sankar, CPC-A
Nilam Mandave, CPC-A
Nina Kristine Sabio, CPC-A
Niquela Cole, CPC-A
Nirmala Boyapati, COC-A
Nisha Darling, COC-A
Nithiya K, COC-A
Nitin Kumar Jaiswal, CPC-A
Nitin Makkar, COC-A
Nitin Verma, CPC-A
Nydia Altamirano, CPC-A
Olanike Dada, CPC-A
Olivia Malardo, CPC-A
Omkaram Venkata Ramesh Babu, CPC-A
Oummaly Barrie, CPC-A
Padma Sree Donthula, CPC-A
Padmanav Dash, COC-A
Paige Evans, CPC-A
Pambala Rohini Priyanka, CPC-A
Pamela Coats, CPC-A
Parimala Nelaturi, COC-A
Parminder Kaur, CPC-A
Parveen Banu, CPC-A
Patil Vaidhyanath Reddy, CPC-A
Patrice Feddes, CPC-A
Patricia Blosser, CPC-A
Patricia Camille Jomento, CPC-A
Patricia Campos Hernandez Franco,
CPC-A
Patricia Depew, CPC-A
Patricia Flynn, CPC-A
Patricia Grabill, CPC-A
Patricia M Gibson, CPC-A
Patrick John Martinez Roca, CPC-A
Paul A Spaziante, CPC-A
Paul Ryan Tolentino Valencia, CPC-A
Paula Perry, CPC-A
Paula Richards Broek, CPC-A

Payton Pelto, CPC-A
Peddinidinesh Nageshwarrao, CPC-A
Peereddy Amani, CPC-A
Peggy Ann Hefner, CPC-A
Penny Hand, CPC-A
Philip Don Nelo Deus, CPC-A
Phillip Brizendine, CPC-A
Pinky Yadav, CPC-A
Polukonda Nalini, CPC-A
Poonam Jawala, COC-A
Poonam Kasawlekar, CPC-A
Potineni Seshendra, CPC-A
Pradeep Reddy Thada, COC-A
Prajakta Digambar Bagde, CPC-A
Pratik Parab, CPC-A
Princess Joy Tumambing, CPC-A
Priscilla Brzezinski, COC-A
Priscilla Pereira, CPC-A
Priya Ravikumar, CPC-A
Priya Venuganandam, CPC-A
Priyanka Kumari, COC-A
Priyanka Rajendran, CPC-A
Puli Manga, COC-A
Puneet Gunjikar, CPC-A
Pushpa Suralkar, CPC-A
Pushpalatha Dhadal, CPC-A
Pushpalatha Sivalingam, COC-A
Qerimane Kelmendi, CPC-A
R. Radha Krishna, CPC-A
Rachael Mahan, CPC-A
Racheal Ann Hill, CPC-A
Rachel Best, CPC-A
Rachel Hofmeister, CPC-A
Rachel Reyes, CPC-A
Raghava Rahul Ravutu, COC-A
Raghavender Dhanwada, COC-A
Rajalakshmi Saminathan, COC-A
Rajesh Puthiyedath, CPC-A
Rakesh Bashabattini, COC-A
Rakesh Rao, COC-A
Rakesh Varma Baindla, COC-A
Ramakrishna Gadasu, COC-A
Ramesh Cherukupally, COC-A
Ramesh Subramanian, COC-A
Ramya Srikumari Vikraman, CPC-A
Ramya Subramanian, CPC-A
Ramya Vadiraj, CPC-A
Randa Dissing, CPC-A
Randi Anderson, CPC-A
Rani Ghogare, CPC-A
Rani Joseph, CPC-A
Ranil Kalarikkal Ravi, COC-A
Raquel Perez, CPC-A
Rasika Narayan Bagade, CPC-A
Ratheesh Nair, CPC-A
Ravali Doddi, COC-A
Ravi Kumar Kasanagottu, CPC-A
Ravi Prema, CPC-A
Ravikiran Yengali, CPC-A
Ravindra Kunwar, COC-A
Raviteja Anumolu, COC-A
Rebecca J Oliver, CPC-A
Rebecca Polyniak, CPC-A
Rebecca Schilling, CPC-A
Rebecca Wells, CPC-A
Regina Mary, CPC-A
Rekha Patel, COC-A
Remi Rangasamy, COC-A
Remya G Kurup, COC-A
Renee M LaRocque, CPC-A
Renee Fox, CPC-A
Renju Raju, COC-A
Renu Jayavel, CPC-A

Renuka Ellappareddy, CPC-A
Renuka Modugu, CPC-A
Reshma Rajan, CPC-A
Reshmi Venugopala Prabhu, CPC-A
Revathi Chitharanjan, CPC-A
Rex Salvado, CPC-A
Reynaldo Llana, CPC-A
Rhonda Riffe, CPC-A
Richard Tamunday, CPC-A
Richelle Bedoya, CPC-A
Rinolucy Menguito Cantong, CPC-A
RiswanaParveen Iqbal, CPC-A
Ritesh Ranjan, CPC-A
Riyaz Khan, COC-A
Robert Huffman II, CPC-A
Robin Bonner, COC-A, CPC-A
Robin Newsome, CPC-A
Robin Schermerhorn, CPC-A
Robyn Hunter, CPC-A
Rohit Anand, CPC-A
Rohit Kumar. S, CPC-A
Roland Hernandez Jr, CPC-A
Romir Aglugub, CPC-A
Rona Gigante De Asis, CPC-A
Roni Berlin, CPC-A, CPB
Rosalie Tabios, CPC-A
Rosalyn Balmes, CPC-A
Rosalyn Jamison-Charles, CPC-A
Rose Deleta McLean, CPC-A
Rosie Guerrero, CPC-A
Rowell Ramon Zaragoza, CPC-A
Roxana Q Mendoza, CPC-A
Roxane Chinoy, CPC-A
Rubeshkumar Gopal, CPC-A
Ruby Ann Moreno Non, CPC-A
Ruby Cabe, CPC-A
Ruby grace Edward, CPC-A
Rupali Raghunath Rokade, CPC-A
Ruthika Sundaragiri, CPC-A
Ryan Johns, COC-A
S Shabana Begum, CPC-A
Sabnapriya Somasundaram, CPC-A
Sabrina Bostian, CPC-A
Sabrina Crawford, CPC-A
Sabrina Romero, CPC-A
Sabrina Torres, CPC-A
Sahana K, CPC-A
Sai Reddy Samala, COC-A
Sai Srinivas, COC-A
Sai Susmitha Daggubati, CPC-A
Samantha Litmer, CPC-A
Samantha Maguire, CPC-A
Sampath M, CPC-A
Samrat Penjarla, COC-A
Samrin Fathima Imtiaz Hussain, CPC-A
Sana Mirasahab Shaikh, CPC-A
Sandeep Sikar, COC-A
Sandhya Pandiri, CPC-A
Sandip Wagh, CPC-A
Sandra Bales, CPC-A
Sandra Kimura, CPC-A
Sandy Guthrie, CPC-A
Sanitha Narayanan, CPC-A
Sanjay Patil, CPC-A
Sanjaykumar Bhupathi, COC-A
Sankararao Gullipalli, COC-A
Santhi Bandaru, CPC-A
Santhi Muttha, CPC-A
Sarah Dobrovolny, CPC-A
Sarah Perkins, CPC-A
Sarath Chandran Chandran, CPC-A
Saravani Thiyagarajan, CPC-A
Sarina Alexis Fullmer, CPC-A

Saritha Reddy G, CPC-A
Sasidhar Aradyula, CPC-A
Satartia Christine Collins, CPC-A
Sateesh Gummadi, CPC-A
Sathishkumar Munuswamy, COC-A
Sathya Priya Kittusami, CPC-A
Schani Marie OBrien, CPC-A
Schmeca Lawrence, CPC-A
Sebi Pappachan, COC-A
Seema Atul Paradkar, CPC-A
Seema Kumar, CPC-A
Seetha Arumugam, CPC-A
Selena Cameron, CPC-A
Selvarani Suresh, CPC-A
Senthil Venkatesan, CPC-A
Shabbir Hussain K Mohammed, CPC-A
Shaira Myn Herrera, CPC-A
Shalini Dillibabu, CPC-A
Shanice Johnson, CPC-A
Shankar Chandragiri, CPC-A
Shannon Saunders, CPC-A
Shanthi Priya, CPC-A
Shara Elaine Klem, CPC-A
Sharada Kalakota, CPC-A
Sharat Kumar, CPC-A
Sharon Erickson, CPC-A
Shashi Kant, CPC-A, CIC
Shashi Kiran, COC-A
Shawn Gantz, CPC-A
Shawna Wallace, CPC-A
Shay Peterson, CPC-A
Sheeba Inasu, CPC-A
Sheeooli Nag, CPC-A
Sheetal Vasoya, CPC-A
Sheila Lund, CPC-A
Shelley Shafer, COC-A
Sherbanu Ahmed Sayyed, CPC-A
Sheri Vickery, CPC-A
Sherita Mitchell, CPC-A
Sherri Pearce, COC-A
Sherri Shink, CPC-A
Sherry Bounds, CPC-A
Sherry De Castro Balbuena, CPC-A
Sherry Deig, CPC-A
Sheryl Denny, CPC-A
Shibashish Mohanta, COC-A
Shifa Mahzabin, CPC-A
Shikha Pathak, COC-A
Shirley Belken, COC-A
Shoban Raj A V, CPC-A
Shobhit Kumar, CPC-A
Shridhar Ekanekar, COC-A
Shrutidhar Kanhaiya, CPC-A
Shrutiyogesh Kini, CPC-A
Shumaila Ansari, CPC-A
Shwetha Ayathan, COC-A
Sibbie Pauline Frazier, CPC-A
Siddhanta Mishra, CPC-A
Siddhartha Madala, COC-A
Silpa C, CPC-A
Silvia C Quant, CPC-A
Simeon Sampathkumar, COC-A
Simone Thompson, CPC-A
Simple Patel, CPC-A
Sneha Dhake, CPC-A
Snehajagannath Patil, CPC-A
Sonakshi Singh, CPC-A
Sonia DaSilva, CPC-A
Sonia Luke, CPC-A
Sonia Rawat, CPC-A
Soniya T Joseph, CPC-A
Sophia Bell, CPC-A
Soumyashree Choudhury, CPC-A

Sowmya Pappu, CPC-A
Sowmya Rangan, CPC-A
Sravani Goli, CPC-A
Sravanthi Gorusu, COC-A
Sreerag Vageeswari, COC-A
Sridhar Rao Muthineni, COC-A
Sriharsha Bugude, COC-A, CPC-A
Srilekha Baskar, CPC-A
Srinivas Kanthala, CPC-A
Srinivas Reddy Narahari, COC-A
Srinivas Thatipamula, COC-A
Srinivas Vadde, COC-A
Srinivasan Govardhanan, CPC-A
Srinuvali Shaik, COC-A
Sruthi Reddy G, CPC-A
Sruthy Hari, COC-A
Stacey A Sam, CPC-A
Stacy Ann Johnson, CPC-A
Starla Ehrisman, CPC-A
Steffi Shae Uy, CPC-A
StellaMary Arokiasamy, CPC-A
Stephanie Clarke-Mahoney, CPC-A
Stephanie Marie Reed, CPC-A
Stephanie Miranda Shore, CPC-A
Stephanie Ristau, CPC-A
Stephanie Wright, CPC-A
Stephen Dong, CPC-A
Stephen Ledford, CPC-A
Subbaravamma Kommareddy, CPC-A
Sucheta Sarkar, CPC-A
Suchita Gawand, CPC-A
Sudha Paramasivam, COC-A
Sudhir Kumar, CPC-A
Sudhir Mohan, CPC-A
Sujith kumar Telly, COC-A
Sujiva Kumari Anton, CPC-A
Suman Kalaidoss, COC-A
Suman Shreyaah, CPC-A
Sumanreddy Samala, COC-A
Sumit Kumar, CPC-A
Sumitnagsen Shishupal, CPC-A
Sundaravani Elangovan, CPC-A
Suneel Kumar, COC-A
Sunil Kumar Metta, COC-A
Sunny Puri, CPC-A
Surekha Banda, COC-A
Suresh Bellam, CPC-A
Surja Sikha De Roy, CPC-A
Susan Gonzalez, CPC-A
Susan Marini, CPC-A
Susan Scott, CPC-A
Susan Smith, CPC-A
Susan Valadas, CPC-A
Sushil Kumar, CPC-A
Sushma Chintha, CPC-A
Sushma Kamuni, COC-A
Suzanne Carino, CPC-A
Swathi Kethireddy, CPC-A
Swathi Mangelipelly, CPC-A
Swathi Shyamsunder, CPC-A
Swathisaranya Chitikila, CPC-A
Sweety Pavithran, CPC-A
Syamala Chityal, CPC-A
Syed Shakeer Ali, CPC-A
Sylvia Emmanuelle Krieg, CPC-A
Tadi Sivaparvathi Reddy, CPC-A
Talluri Kranthi Kumar, COC-A
Tamara Detillo, COC-A, CPC-A
Tamara Ingram, CPC-A
Tamara Yamin, CPC-A
Tammy Alexander, CPC-A
Tammy Derk, CPC-A
www.aapc.com
April 2016
63

Tanya Reppert, CPC-A
Tapaswi More, CPC-A
Tasha Tribune, CPC-A
Taylor Brnik, CPC-A
Taylor Thompson, CPC-A
Tehzibali Saiyad, CPC-A
Teja Babu Addanki, COC-A
Tejpattie Lachman, CPC-A
Teonna Benning, CPC-A
Teresa Bezek, CPC-A
Teresa Klein, CPC-A
Teresa Luciana Anderson, CPC-A
Terra Clarke, CPC-A
Terrence Gaylon, CPC-A
Terri-Karlene Peart, CPC-A
Thelma Josephs, CPC-A
Theresa Milligan, CPC-A
Thota Venkatesh, COC-A
Thumma Thomas Reddy, COC-A
Tiana Broadhead, CPC-A
Tiff Weilbacher, CPC-A
Tiffany Buckmiller, CPC-A
Tiffany Gandy, CPC-A
Tiffini Hunter, CPC-A
Tracey Bonner, CPC-A
Tracey Henderson, CPC-A
Tracy Doyle, CPC-A
Tracy Holcombe, CPC-A
Tracy Lynn Ellis, CPC-A
Tracy Marshall, CPC-A
Tricia M Brown, CPC-A
Ty Moltmann, CPC-A
Tylar S Melton, CPC-A
Uday Banu Brundam, COC-A
Uma Devi Nagappan, CPC-A
Uma Maheswari, CPC-A
Umesh D, CPC-A
Upinder Walia, CPC-A
Urszula Ochman, CPC-A
Usharani Rajaraman, CPC-A
V N S Manikanta Perumalla, COC-A
V Chaitanya Prasad, CPC-A
V Gangadhar Reddy, CPC-A
V Prema Latha, CPC-A
Vaishnavi Deenadayalan, COC-A
Valerie Gillen, CPC-A
Valerie Morris, CPC-A
Vandana Teckchandani, COC-A
Vandana Vanam, CPC-A
Vanessa Blacano, CPC-A
Vanessa Carter Ray, CPC-A
Vani Kammari, CPC-A
Varshil Patel, CPC-A
Vasanthi Paulraj, CPC-A
Vasanthi Ramineni, CPC-A
Veena Raju, COC-A
Veeralakshmi Nallaiah, CPC-A
Vemulapalli Namrata, CPC-A
Venkata Apparao Yandrapu, COC-A
Venkatachalapathy Thoppayan, COC-A
Venkateswara Raju Bollepally, CPC-A
Venu Gopal, COC-A
Vernetta Dunbar, CPC-A
Veronica Bentley, CPC-A
Veronica Lynn Hurley, CPC-A
Vevie Gilliam, CPC-A
Vicki Halverson, CPC-A
Vicki Hersey, CPC-A
Victor Changanaqui, CPC-A
Vida Carmen Del Rio, CPC-A
Vidhi Shrimali, CPC-A
Vidhyalakshmi Ranganathan, CPC-A
Vidya Marudhavanan, COC-A
64
Vijay Kumar Dunka, CPC-A

Vijaya Thatha, CPC-A
Vijayakumar Manickam Pillai, COC-A
Vikki N Perry, CPC-A
Vincent Legaria, CPC-A
Vineet Chauhan, CPC-A
Vinni Narayanasamy, CPC-A, CRC
Vinothkumar Vijayarangan, COC-A
Virendra Kumar Singh, CPC-A
Virginia OBrien, CPC-A
VML Eswararao Gummadi, COC-A
Vonda Mendez, CPC-A
Wanda Williamson, CPC-A
Wendy Hoachlander, CPC-A
Wendy Silver, CPC-A
Wesley Woodard, CPC-A
Willard Perry, CPC-A
Willy Ferrer Pagarigan, COC-A
Xay Chao, CPC-A
Yacquelyn Sosa, COC-A
Yaima Ramos, CPC-A
Yamily Simon, CPC-A
Yarabolu Sahithi, CPC-A
Yasmin Shaik, COC-A
Yilian Lopez, CPC-A
Yn Shivakumari, COC-A
Yoga Priya N Narayanan, CPC-A
Yurisay Vergara, CPC-A
Yuvaraj Venkatesan, CPC-A
Yvonne Ogden, CPC-A
Zacarias Cometa, CPC-A
Zaria Morales, CPC-A
Zayd Hamza, CPC-A
Zoila de La Cruz, CPC-A
Zullyn Ball, CPC-A, CPMA
Specialties
Abhinav Kumar Maurya, CPC-A, CIC
Afiya Richards, CPC, CPMA
Aileen Panganiban, CIC
Ajudia Rupal Damjibhai, CIC
Alexandra Garkey, CPB
Alexis Perez, CPB
Alfredo Ramones, CIC
Alisa Hermansen, CPC, CPC-I, CRC
Alva Elano, CRC
Alvin Cyrel Albino, CIC
Amaechi Lawrence Ofunne, CPC, CPMA,
CEMC, CGSC, CPRC
Amanda Castro, CPB
Amanda Proctor, CPC, CRC
Amit Dhingra, CIC
Amy Fields, CPC, CRC
Amy M Decker, CPC, CRC
Amy Powell Gross, CPB, COBGC
Amy Shilliam, CPC, CPCO
Amy Walker, COC, CPC, CPB, CPMA,
CEDC, CRC
Anand Babu Ponnusamy, COC, CPC, CIC
Ananda Kumar, CPC, CRC
Anandhan Sivagnanam, CPC, CPMA
Andrea Crowe, CPB, COBGC
Andrea Mitchell, CPC, CRC
Angela D Brown, CPC, COSC
Angela Larsen, CPC, CRC
Angela S Romero, CPC, CEMC
Angela Swartz, CPC, CPB
Angelica Gatchalian, CIC
Angelique Wilson, CPC, CRC
Anirudh Ekbote, CPC, CIC
Ann Wurtinger, CPC, CIC

Anne Brown, CPC, CPB, CPMA, CIMC
Anne C Strout, COC, CPC, CRC
Anne Turla Solomon, CIC
Antoinette Hill, CRC
Anuradha Sankarraj, CIC
Anusha Bonasu, CIC
Aparna Ravinuthala, CRC
April Christine Adams, CPC, CRC
Araceli Linn, CPC, COBGC
Arejay Tabaquero, CRC
Arisa Lynn Widrick, CPC, CPMA
Arlene E Wilkins, CPC, CRC
Asaithambi Dhanapal, COC, CPC, CIC
Ashfaq Mohammad, CIC
Ashlea Kerley, CPCO
Ashvini Arun Jagtap, CPC-A, CIC
Asokar Arasu, CPC, CPMA, CANPC
Audrey Bergstrom, CPB
Avinash Daripally, CIC
Barbara A Williams, CPC, CRC
Barbara Gonzalez, COC, CPC, CPMA,
CRC
Barbara Reyes, CPC, CPMA
Bart Stein, CPC, CPCO, CEMC
Becky Bertrand, CPC, CEMC
Becky Dunn, CPCO
Belissa Cipreni Thompson, CRC
Beth Ann Buchanan, CPC, CANPC
Beth Anne Hickey, CPC, CFPC
Bhaskar Kolli, CIC
Bhuvaneshwari Palanisamy, CIC
Bianca Otto, CPMA
Birgit Otto, CPC, CPMA
Blummenroth Otto, CPMA
Brenda Brock, CPC-A, CPB
Bridget Jones, CPC, CRC
Bridget Nutter, CPC, CPB
Bronwyn Hadlock, CPCO
C Juliette Morell, CPC, CPMA
Camille VanDerSteen, CPC, CIRCC, CCC
Candice Dyxse Czelusniak, CPC, CRC
Cara Erlenwein, CPC-A, CHONC
Caren Joy Mesias, CIC
Carey Ketelsen, CRC
Carla B Williams, CPC, CEMC, CGSC
Carletta Ellen Vasknetz, CPC, CPMA
Carol Sager, CPCO
Caroline Faulkner, CIC
Caroline R Epperly, CPC, COSC
Carrie E Caldewey, CPC, CPMA
Catherine A Phipps, CPC, CPMA, COBGC,
CRC
Cathy L Smith, CPB
Chad Benjamin Peterson, CPC, CEMC
Chad Tubbs, CIRCC
Chaitanya Pamba, CIC
Chandra Lynn Stephenson, COC, CPC,
CPCO, CPB, CPMA, CPC-I, CANPC,
CCC, CEMC, CFPC, CGSC, CIC, CIMC,
COSC, CRC
Chandrashekar Reddy Muttannagari, CIC
Chaniece Evans, CPC-A, CPMA
Charles Solomon Raja, CPC, CPMA,
CGSC
Charles Zulauf, CPC, CIC
Cheryl Bendana, CIC
Cheryl Ben-David, CPC, CRC
Cheryl R Berzat, CPC, CPMA, CIMC
Cheryl Reynolds, CPC, CRC
Christine Coppola, CPC, CRC
Christine Peterson, CPC, CEMC
Christine Smith, CPC, CRC
Christy Szolis, COC, CPC, CRC

Cindy Nixon Hall, CPC, CGSC
Cindy Y Lopez, CPC, CPMA
Clemente Guido, CPB
Courtney Jones, CPC, CPCO
Crystal Romat, COC, CPC, CRC
Cynthia Leslie, CPC, COBGC
Cynthia Lynn Hubbard, CPC, CGIC
Dana Radack, CPC, CRC
Daniel Richard Francis, COC, CPC, CIC
Daniel Rowden, COC, CPC, CPCO,
CPMA, CIC
Daniela Simoski, CPC-A, CPB
Danielle Ann Misin, CPC, CPMA
Danielle Shanklin, CEDC
Darby Amezcua, CPPM
Darwin Roque Santos, CIC
Dawn Lambert, COC, CPPM
Dawn M Fenwick, CPC, CPB
Deanna Householder, CPB
Deborah Lloyd, CPC-A, CRC
Debra Ann Keyes, CPC, CCC
Debra Johnson-Phythian, CPMA, CRC
Delia Delatorre, CRC
Denise Majoris, CPC, CRC
Diane Gotkin, CPC, CRC
Diane Herbeck, CPC, CPB
Diane Walczak, CPC, CPMA, CUC
Divya G Gopinathan, CRC
Divya Jyothi Gadapa, CIC
Donita Mallak, CPC, CPB, CGSC
Donna Barrameda Cabugos, CRC
Donna Lynn Barker, CPC, CPCO, CPMA,
CPC-I
Donna Stefonetti, CRC
Doris V Branker, CPC, CIRCC, CPC-I,
CANPC, CEMC
Durga Devi, CIC
Dwijesh Udvij, COC, CPC, CIC
Edward Bosita Ringor, CPC, CRC
Eileen Pinares, CPC, CPMA, CPC-I, CRC
Elaine Fischer, CPC, CRC
Elan Neuman, CPPM
Elizabeth A Williams, CPC, CPB
Elsa Brinkman, CPC, CGIC
Enriqueta Almeida, CPC, CPMA, CPPM
Eric Stephens, CPPM
Erina Master, CPPM
Erlinda S Balaan, CPC, CPEDC, CRC
Erra Samatha, CIC
Erwin Salud, CIC
Esther Walker, CPB
Evelynn McCulloch-Owens, CCS, CPC-A,
CRC
Fallon Charisse Brown, CPC, CPMA
Fasiya Ahamed, CPC, CPMA
Fathima Begum Jaffer ali, CRC
Frances Easter, CRC
Gaddala Jhansirani, CIC
Gadeela Narender Reddy, CIC
Gail A Volpi, COC, CPC, CIC, CRC
Gail Bricker, CPC, CPB
Ganesh Bhoje, CPC, CIC
Golla Pavani, CIC
Gowsalya M Murugesan, CRC
Graciela Alvarez, CPC, CPMA
Guia Zhao, CPC, CIC
Gurram Sudhaveeru, CIC
Hanna Roman, CRC
Hannah Howald, CPC, CPMA, CPPM
Harika Sambu, CIC
Harikrishna Soorishetty, CIC
Harriet Thomas-Fryer, COC, CPC-P,
CPMA, CRC
Heather McCallum, CPC, CCC
Helen Kirkland, CPB
Hilda Garcia, CPC, CPMA
Hillary Julien, CPCO
Himanshu Sharma, CPC-A, CIC
Hollie Lindley, CPB
Imamsaheb Shaik, CIC
Inay Iriban, CPC, CPMA
Indhira Kalaiparthiban Rajendran, CIC
Ines Agnes Morales, CIC
Izel Silva, CPC, CPMA, CRC
Jade Ariel Reeves, CPC, COBGC
Jagjeet Singh, CIC
Jamie Addler, COC, CPB, CPMA
Jamie Jo Pool, CPC, CPB
Jamie Taylor, CPB
Jan Lambert, CRC
Jan Marie Flanders, COC, CPC, CASCC
Jana Gustafson, COC, CPC, CPCO,
CPMA, CRC
Jana Morgan, CPB
Janice Douglas, CPC, CPMA, CEMC
Janice Raffa, CPC-A, CRC
Janis Stelzner, CPC, CRC
Jason Knowles, CPCO
Javeed Mohamed Kalil, CPC, CIC
Jayalakshmi Kulanthaimani, CRC
Jayesh Ramteke, CPC, CRC
Jefferson Esperida, CRC
Jelene Roxas, CPB
Jennie E Moody, COC, CPC, CRC
Jennifer Kniffen, CPC, CGSC
Jennifer L Deal, CPC, CPMA, CEMC
Jenny Harvey, CPC, CPMA
Jerame Capacia-Castro, CRC
Jessica Fenolio, COC, CPB, CASCC
Jhan Jester Solmoro, CPC-A, CIC
Joan Aileen Del Mundo, CIC
Joan M Bartholomew, COC, CPC, CRC
Joan Marie Dion, CPC, CRC
Jodi Long, CPB
Jody Hart, CPC, CRC
Jody Mortensen, CPC, CEMC
John Philip Martinez, CIC
John Ray Elders, COC, CRC
John Sauder, CPC, CPPM
Jonel Gomez, CPCO
Joseph Hughes, CPPM
Joy Anne Monteverde, CRC
Joyce Daquipil, CIC
Judith Andrea Facey, CPC-P, CRC
Judith Carol Quesnel, COBGC
Judybeth Fernandez, CPC, CPC-P, CRC
Julia Brauer, CPB
Julianne Thomas, CPC, CRC
Justine Basa Asilo-Daelo, CPC, CPMA
Kamaal Ahmed, CIC
Karen Fan, COC, CPC, CRC
Karen Summers Clinard, CPC-P-A, CRC
Karen Tinoco, CPC, CPMA, CRC
Karen Webb, CPC, CANPC, CIC, CPCD
Karen Worrell, CPB
Karen Y Manigault, CPC, CPMA, CEDC,
CEMC
Kari Leigh Giles, CPC, CRC
Karthick Jayaraj, CPC, CEDC
Karthikeyan Thandapani, CIC
Kasinath Thalikota, CIC
Kathleen Guzzi, CPC, CIC
Kathleen M Skolnick, COC, CPC, CPCO,
CPB, CPMA, CPPM, CPC-I, CEMC, CRC
Kathryn Jones, CPC, CRC

Kathryn Joyce Phillis, CPC, CPB, CPC-I
Kathryn R. Melton, CPC, CRC
Kathy LaPierre, CPC, CPMA, CEDC,
CEMC
Katie Lee Cheong, CPC, CENTC
Katrina Woodring, CPC, CPC-P, CPC-I,
CRC
Kawana N Scott, CPC, CPMA, CEDC
Kayla Williams, CPC, CEDC
Kellie Louise Zimmerman, CPC, CRC
Kelly Moritz, CIC
Kelly Johnson, CPC, CPC-P, CENTC,
CFPC
Kelly McCormick, CPC, CPC-P, CRC
Kelsey Storey, CPC, COBGC
Kendra Hamiel, CPB
Kilona Kara, CPC-A, CRC
Kim F Turner, CPC, COSC
Kim Fields, CPC, CRC
Kim Montenegro, CPC, CPMA, CPC-I,
COSC, CSFAC
Kim Morvant, CPC, CRC
Kimberly J Fields, CPC-A, CPMA
Kimberly Salazar, CRC
Kimberly T Dues, CPC, CRC
Kimothy Williams, CPC, CPB
Kristina Bolio, CRC
Kristina Marie Metrejean, CPC, CPB
Kristine Diana West, CPC, CPMA
Kurt Alyn Kaskie, CPC, CRC
Kushali Cherukumalli, CIC
Kynet Watkins, CPCO
LaBrena Settles, CPCO
Lanileen Caisip, CIC
Larry Roberson, CPC, CPMA, CRC
Laura Duffy, CPC, CPMA
Laurie Elliott, CPB
Leann Haven, CPPM
Lenette Russell, CPB
Leyiset Crespo, CPC, CRC
Liana Urdanivia, CPC, CPMA
Libest J Larez, CPC-A, CPB, CPMA
Lilian Russo, CPC, CPMA, CUC
Lina Liza Arcilla Alcances, CPC, CPC-I,
CIC
Linda D Hall, CPC, COSC
Linda Manuli Huckin, CPC, CIC
Linda Marshburn, CPPM
Linda R Farrington, CPC, CPMA, CPC-I,
CRC
Linda Thomas, CPC, CRC
Lisa Maria McIlquham, CPB
Lisa Bradshaw, COC, CPC, CHONC
Lisa Griswold, CPC, COSC
Lisa Janell Fouts, CPC, CPMA
Lisa L Rogers, CPC, CRC
Lisa M. Noles, CPC, CPCO, CPC-I
Lisa Magnotti, CPC, CRC
Lisa Purnell, CPC, CPCO, CPMA, CRC
Lisa Sandusky, CPC, CPMA, CANPC
Lisa Swanson, COC-A, CPC-A, CPC-P-A,
CPB
Lokesh Gupta, CPC, CRC
Lori Lingo, CPC, CRC
Lourdes Suarez, CPC, CPMA
Lourdes Valbuena, CPC, CPMA, CEMC
Lynda Knighton, CPMA
Machaelle M Diaz, CPC, CPMA, CRC
Majas Fayaz, CRC
Malakondaiah Gotha, CPC-A, CIC
Malana Skolnick, COC, CPC, CPCO,
CPMA, CPPM, CEMC, CRC
Malissa Amend, CPC, CPMA
Manjunath Ballappa, CIC

Manuel De Jesus Grullon, CPC, CPMA,
CRC
Maram Harish, CRC
Marbella Patino, CPC, CPMA
Marcie Small, CCS, CPC-A, CRC
Marcy Short, CPPM
Maria A Joseph, CPC, CPCO, CPMA,
CEDC, CEMC
Maria Boyd, COC, CPC, CPC-P, CEMC
Marie Bergin, CPC, CCVTC
Mark Anthony Marlangawe, CIC
Marnetia Spratley-Pruden, CPC, CPMA,
CANPC, CRC
Marsha Sporhase, CPC, CPMA, CRC
Martha L Gaviria, CPC, CPMA, CRC
Martha Tokos, CPC, CPMA, CPC-I, CRC
Mary Elizabeth Grimmett, CPC, CRC
Mary Jane Dickey, CPC, CPB
Mary M Murphy, CPC, CRC
Mary Rountree, COC, CIC
Mary-Jo Griffith, CPC, CPC-I, CEMC,
CGIC, CGSC, COSC
Maryline Medina, CPC, CRC
Mathanagopal Pandiarajan, CRC
Matilde Perez Chon, CPC-A, CRC
Maya Mohan, CIC
McKenzie Harrison, CPMA
Melanie Rae Edwards, CPC, CPCO,
CPMA
Melissa Brownlow, CPC, CPMA
Melissa Burke, CPC-A, CRC
Melissa Troiano, CPMA, CPPM
Michele Brassell, CPC, CRC
Michele Gibbs, CPPM
Michele R Hayes, CPC, CPMA, CPC-I,
CEMC, CGIC, CRC
Michelle D Reese, CPC, CRC
Michelle Hartley, COC, CPC, CRC
Michelle Lopez, CPC, COBGC
Michelle M Mesley-Netoskie, CPC, CPPM
Michelle R Davis, CPC, CPB, COBGC
Michelle Santos, CIC
Mikel Miller-Edwards, CPC, CPMA
Mildred I Hanna, CPC, CPCO
Mohammed Mazheruddin, CIC
Monica Marie Diaz, CPC, CRC
Muthaiya Murugappan, CIC
Nadia Campbell-Johnson, CPMA
Nafeeza Abzal, CPC, CGSC
Nagaraj Varadharaju, CRC
Najuma Syeduebrahim, CIC
Nancy Martin, CPC, CPPM
Nancy Zizelman, CPC, CPB, CRC
Nandhakumar Deenadhayalan, CPC, CIC
Nanette Driscoll, CPC, CPMA, CPPM
Narda J Mattos, CPC, CPMA
Narendathu Cherla, COC-A, CIC
Nasir Mire, COC-A, CPMA
Nathan L Kennedy, Jr, CPC, CPB, CPPM,
CPC-I
Naveen Kumar Nanamala, CIC
Naveen Kumar Ch, CIC
Naveena E Dineshkumar, CIC
Neelima Akula, CRC
Neelima Haneesha Dara, CIC
Nicole K Worobel, CPC, CPMA, CGSC
Nieve Garcia, CPC, CGIC
Nilesh Tukaram Lad, CPC, CIC
Palani Balasubramaniam, CPC, CPMA,
CEMC
Pam Wayman, CPC, CCC, CCVTC
Pamela Joan Bess, CPB
Pamela Trisler, CPC, CRC

Patrice Zezza, CPC, CRC
Patricia A Smith RHIT, CPC, CPMA,
CEMC
Paula J Dubel, COC, CPC, CPC-I, CIC
Pauline Hernandez, CPB
Pedro Camejo, CRC
Peter Wamen Lau, CPB
Phoebe L Moore, COC, CPC, CRC
Phyllis Ingram, CPB
Pichi Reddy Boggula, CRC
Pradeep Kalmat, CPB
Pragati Yadav, COC-A, CIC
Prithviraj Reddy Patlolla, CIC
Priyanka Bharathi, CIC
Pulla Rao Rao Penke, CIC
Racheal Hernandez, CPB
Rachel A Hively, CPC, CPMA
Rachelle Rea, CPC, CRC
Rahul Ghanshyam Thorave, CIC
Rahul Sukhdev Talekar, CIC
Rajasekharnaik G, CIC
Rajat Puri, CPC-A, CIC
Rajesh Mannam, CIC
Rajesh Singam, CPC-A, CIC
Rajeswari Muthaiah, CPC, CPMA
Rajkumar Santhanam, CIC
Rajmohan Alagarsamy, CPC-A, CIC
Raju Shivanathri, CIC
Rakesh Kumar, CIC
Rakesh Yemineni, CPC-A, CIC
Ramasubbu Subburayalu, COC, CPC,
CPCO, CPC-P, CIRCC, CPB, CPMA,
CPPM, CANPC, CASCC, CCC, CCVTC,
CEDC, CEMC, CENTC, CFPC, CGIC,
CGSC, CHONC, CIC, CIMC, COBGC,
COSC, CPCD, CPEDC, CPRC, CRC,
CRHC, CSFAC, CUC
Ramon Lucero Radoc, CPC, CRC
Ranjani Venkat, CIC
Ranjith Telu, CIC
Ravi Mannela, CIC
RaviKumar Alluri, CIC
Ravikumar Dobbala, CIC
Reather M Westbrook, CPC, CRC
Rebecca Erickson, CPB
Rebecca Lynn Hanif, CPC, CPCO, CPMA
Renee Connor, COC, CPC, CPC-I, CANPC,
CEDC, CEMC, CRC
Rhazel Adoyo, CRC
Richard Carreon, CIC
Rita D Bobbitt, CPC, CRC
Robin Doerfler, CPC-A, CRC
Robin Henry, CPC, CPPM
Rochelle G Johnson, CFPC
Roni Berlin, CPC-A, CPB
Roshan Lal, CPC-A, CIC
Ruby Catherine OBrochta-Woodward,
CPC, CPB, CPMA, COSC, CSFAC
Ruchira Narayanan, CPC, CRC
Ruth Spinelli, CPC, CPMA, CIC
Sahera Banu, CIC
Saisree Ravindranath, CPC, CPMA
Sambaiah Deshini, CIC
Samira Khalaf, CPCO
Sandra Chamberlin, CPC, CPC-I, CRC
Sangareddy Paidi, CIC
Sanoop George, COC-A, CPMA
Sarah E Pross, CPC, CPB, CFPC
Sarah E Pross, CPC, CPB, CFPC
Sarah Malin, CPC-A, CPB
Sarah Marcelle, CPC, CRC
Sarah Spivey, CPC, CRC
Saravanan Thangarasu, CPC-A, CIC

Saravanan Thulasingam, COC, CPC,
CPMA, CEMC
Sateesh Rayapati, CPC-A, CIC
Sateesh Reddy Malle, COC-A, CIC
Savita Kumari, CPC-A, CIC
Scott Smith, CPC-A, CPMA
Shadrach Viswanth Chembeti, CIC
Shaik Ahmed Sharief, CIC
Shakeda Jenrette, CPEDC
Shalini Nanjappan, COC, CPMA
Sharon M Casto, CPC, CEDC, COSC
Shashi Kant, CPC-A, CIC
Shashikala Elumalai Mrs, COC-A, CIC
Sheryl T Witter, COC, CPC, CPC-I, CRC
Shivashankar Sadila, CIC
Shravya Vaddiraju, CIC
Shu Zhen Liu, CPC, CIRCC, CCC, CCVTC
Shuvendu Kumar Sahoo, CIC
Shyam sunder goud Panjala, CIC
Siddharthi Nagaraj, CRC
Silvia Lassales, COC, CPC-P, CPMA, CRC
Sindhuja Gothandaraman, CIC
Smita Suresh Bandre, CPC, CEMC
Sobih Abdurahman, CPPM
Sonia Devereaux, CPB
Sophia Scott, CPC, CRC
Sreedhar Kondapalli, CPMA
Sridhar Chitla, CIC
Srujana Jagati, CIC
Stacey Howe, CPMA
Stephanie Johnson, CEDC
Stephanie Darlington, COC, CPC, CIC
Stephanie Garst, COC, CPC, CPMA
Stephanie Reynolds Garrick, CPC, CPMA
Subodh Awana, CPC-A, CIC
Sudheer Kumar Bachu, CIC
Sue E Davis, CPC, CRC
Sukendhar Reddy Malipatlolla, CIC
Sukumar Vankavarasa, CIC
Summer Johnson, CPB
Sunday A Adesina, CPCO
Sunil Raj Natarajan Krishnamma, COC,
CIC
Sunny Samrat Meka, CIC
Suresh Jumple, CPC-A, CIC
Suriya Gunasekaran, CIC
Surya Prakash Kakumanu, CIC
Susan Jantz, CRC
Susan Mecodangelo, COC, CPC, CRC
Suyin Cecilia Borrero, CPC, CPMA
Suzanne Maureen Santellanes RN, CPC,
CPMA, CRC
Swetha Jagari, CIC
Sydra Wynette Paige, CPC, CIRCC
Sylvia Ramones, CIC
Tabitha Sauls, CRC
Takeda McTear, CPC, CPMA
Tammy Darlene Harris, CPC, CRC
Tammy G Phillips, CPC, CPMA
Tammy Marie Anderson, CPMA, CEMC
Tanya E Perales, CPC, CCC
Tawana Johnson McIver, COC, CPC, CPCP, CPC-I, CIC
Teena Long, CPC-A, CPMA
Teresa Suzanne Bartrom, CPC, CPB
Teri Mauro, CPB
Terri A King, CPC, CRC
Thelma Stewart, CPC, CPMA
Theresa Thompson, CPC, CCC, CCVTC
Theresa W Burnett, CPC, CRC
Thirukumaran Jayasankar, CPC-A, CIC
Thirumozhi Mgk, CPC, CIC
Thirupathi Puppala, CIC

Thomasina L Young, CPC, CPCO, CPMA,
CRC
Tichelle Lyons, CPB
Tiffiney R McDaniel, CPC, CIRCC
Tina Jonas, CPC, CPMA
Tonya Berndt, CPB
Tracy Bowers, CPC, CPB, CPPM
Tracy Rink, CPC, CEDC, CEMC
Trina Empey, CPC, CRC
Tyling M Batista, CPC, CPMA, CEMC
Uma Maheswari, CPC, CIC
Usha Pandiyan, CPC-A, CIC
Vaitheeswaran Purusothaman, CPC,
CPMA
Vamshi Krishna Aluvala, CIC
Vanitha Mourthy, CIC
Varalakshmi Joseph, CIC
Venkata Krishna Suresh Pendyala, CPMA
Venkatesh Kanuri, CIC
Vickie Hicks, CPC, COBGC, CRC
Victoria Angela Holmes, CPC, CIRCC
Victoria Russell, CPB
Vidyasagar Godishala, COC-A, CIC
Vijay Pralhad Tiwari, CPC, CIC
Vijay Sundarraj, CPPM
Vijaya Kumar Bhathula, CPC-A, CIC
Vijayakrishna Soorishetty, CIC
Vijaykumar Tammali, CIC
Vinni Narayanasamy, CPC-A, CRC
Virginia N Hylton, CPC, CRC
Vishal Balasaheb Gaikwad, CIC
Vishnu Pavani Kakumanu, CIC
Viswa Manoj Pikkili, CIC
Vivian Washington, COC, CPC, CPMA,
CPC-I
Wendy Ann Higham, CPC, CPB
Wendy Droppleman, CPC, CPMA
Yanira Zeigler, CPC, CPMA
Yesenia Hernandez, CPC, CRC
Yiliana Pena, CPC, CPMA, CRC
Yogesh Pal, CPC-A, CIC
Yolanda Michelle Stewart, CPC-A, CIC
Yolanda Thomas, CPC, CIRCC
Ysabel Lopez, CPC-A, CPCO, CPMA
Zahoor Thekkidi Chalil, CIC
Zaida Cabrejos, CEDC
www.aapc.com
April 2016
65
Minute with a Member
Jeremy Padgett, CPC-A

Student, DeLand, Florida
Going back to
college and getting
my certification
for billing and
coding was the best
decision I ever made.
Tell us a little bit about how you got into

coding, what youve done during your
coding career, and where you work now.
I became a healthcare business professional because I wanted to make a better life for
myself and I was tired of dead-end jobs. I
knew that healthcare was the right choice
for me I had previous experience working as a care provider for my aunt, and then
for an autistic child. I never thought about
medical billing and coding, however, until
a relative suggested it. Going back to college
and getting my certification for billing and
coding was the best decision I ever made. I
really enjoy it.
My plans are to obtain a masters degree
in billing and coding and to open my own
medical billing and coding office.
How has your certification helped you?

My certification has opened many doors
for me that I did not know were there. I
also enjoy the fact that, as a certified coder, I am able to meet many interesting people in my field.
What is your involvement with your local

AAPC chapter?
I am a member, and I am open to helping
any way I can with my local chapter.
If you could do any other job, what would

it be?
Medical billing and coding is the job for me.
What AAPC benefits do you like the most?

I like the help I receive from the organization when looking for a job. Also, the
help they gave me in my preparation for the
Certified Professional Coder (CPC) test,
mainly from Professor Ramsey at Florida
Tech, who helped me a lot.
GOT A MINUTE?
If you are an AAPC member who strives to advance
the business of healthcare, we want to know about it!
Please contact Michelle Dick, executive editor, at
michelle.dick@aapc.com, to learn how to be featured.
66
Do you have any advice for those new to

coding and/or those looking for jobs in
the field?
Stay at it. Its not an easy field, but if you
have the proper training, you can do it. Never give up.
What has been your biggest challenge as
a coder?
I think by biggest challenge was learning
CPT coding.
How do you spend your spare time? Tell

us about your hobbies, family, etc.
I spend my spare time watching pro wrestling and going to pro wrestling events. I am
also a big fan of the Florida State Seminoles
and the Green Bay Packers.
Land
Your
Dream
Job
Land
Your Dream Job
Accelerate your career and remove your apprentice
Accelerate your
career and
your apprentice
designation
withremove
Practicode.
designation with Practicode.
Practicode gives you the experience you need to get the job you want. With over 600
Practicode
gives you
the experience
youone
need
toof
getcoding
the job
you want.and
Withget
over
600
real-world coding
exercises,
youll earn
year
experience
closer
real-world
coding exercises,
youll earn
one year
of coding
and
to removing
your apprentice
status.
Its your
career.experience
Take control
ofget
it. closer
to removing your apprentice status. Its your career. Take control of it.
800-626-2633
800-626-2633
aapc.com/practicode
aapc.com/practicode
Powered by
Powered by
All-in-one
Compliance For All
We reinvented compliance management through a complete, exible solution

that complies with all seven OIG recommendations to ensure youre compliant,
even when audited.
HEALTHICITY.COM/COMPLIANCEMANAGER

US

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

US

Uploaded by

Copyright:

Available Formats

HEALTHCARE

MS-DRG May Spell TROUBLE: 32

Rock the Mock Audit: 48

The Doctor Said What? 52

$695 $345 THROUGH MAY 31

Healthcare Business Monthly | April 2016

Balance Billing: Is It Legal?

28 CPT 2016: Percutaneous Biliary

48 Rock the Mock Audit

58 What (Not) to Wear

David Zielske, MD,

Lisa Jensen, MHBL, FACMPE, CPC

John Verhovshek, MA, CPC

Healthcare Business Monthly | April 2016 | contents

16 Search Online for Healthcare Business Monthly Articles

Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P

John Verhovshek, MA, CPC

26 Conquer Common Billing Errors

32 MS-DRG May Spell TROUBLE for Mechanical Ventilation Billin

Leonta (Lee) Williams, RHIT, CPC, CPCO, CCS, CCDS

38 The Ins and Outs of Inpatient Psychiatric Facility Perspective Payment

Heather Greene, MBA, RHIA, CPC, CPMA

44 2016 OIG Work Plan: Part B Risk Areas

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

Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC

54 The Nine Cs of Clinical Documentation Improvement

Member of the Year

Healthcare Business Monthly

Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P

13 Local Chapter News

Letter from CEO

Letters to the Editor

66 Minute with a Member

10 AAPC National Advisory Board

Online Test Yourself Earn 1 CEU

Students that complete our

For more information or to enroll visit:

Serving 155,000 Members Including You!

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

American Medical Association.......................................13, 53

Healthcare Business Monthly

Ask the Legal Advisory Board

to fraud and abuse, there are a lot of legal ramifications to working in

Healthcare Business Monthly

CPT copyright 2015 American Medical Association. All rights reserved.

Letter from CEO

You Are AAPCs Strength

is a membership organization, a collection of peers who help to improve healthcare for

Be Part of the Fellowship at Conference

Local Chapters: Our Grassroots

Get Excited for May MAYnia

Support Each Other and Strengthen Healthcare

Please send your letters to the editor to:

Letters to the Editor

Coding | Billing | Auditing | Compliance | Practice Management

Our apologies to Michael Strong, MSHA, MBA,

Fight for Insurance Carrier Payment: 27

The NPP Scope of Practice Scoop: 48

Time Is Ticking on Old Accounts: 55

Speak Up and Be Heard!

Do you have a question regarding information found in Healthcare Business Monthly?

Spreading AAPC Love

If you post on AAPCs Facebook page, many