5/2/2014. Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Disclaimer. Stay in touch through Facebook Please note

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1 Disclaimer Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Presented by: Judy B Breuker, CPC, CPMA, CCS P, CDIP, CHC, CHCA, CEMC, AHIMA Approved ICD 10 CM/PCS Trainer The class is intended to offer information on basic medical billing and coding. Nothing during the class period should be considered a legal/consulting opinion. The instructor does not accept any responsibility or liability with regards to errors, omissions or misinterpretations. The instructor does not accept any responsibility or liability with regards to the printed material distributed. Stay in touch through Facebook Please note Search for Medical Education Services, LLC in the FB search bar Posted information will contain answers to frequently asked questions, suggested websites and career opportunities. Phone calls, texting and e mailing are not permitted during the education sessions. Feel free to step outside the room. This session may not be recorded. The entire presentation will not be distributed due to copyright laws. Agenda Overview of Coding: CPT codes, HCPCS and Diagnosis codes. Modifiers Overview of the National Correct Coding Initiative Certification programs Overview of resources on the internet O i f C di Overview of Coding: CPT codes, HCPCS codes and Diagnosis Codes 1

2 CPT CPT: Current Terminology Published by the American Association. Updated books are released in October. The new codes become effective January 1 of the next year. The purpose of the coding system is to provide language that accurately describes medical, surgical, and diagnostic. The CPT coding system describes how to report procedures or services. What is CPT? A CPT code is a digit numeric code that is used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are approximately 7,800 CPT codes ranging from through digit modifiers may be appended when appropriate to clarify or modify the description of the procedure. Highly recommended resource I use CodeManager everyday that I am coding, auditing or training. In addition I use the add ons: CPT Assistant Online (20 years of reference materials), CPT Changes Online (interpretation and rationale for every code and guideline change and Clinical Examples in Radiology Online (Co published by the AMA and the American College of Radiology, access to archived articles since 2005 with an operative report and test case in each issue). One login gives access to all of the above listed resources What is HCPCS? HCPCS: Healthcare Procedure Coding System Maintained by Centers for Medicare and Medicaid Services (CMS). Updated quarterly. HCPCS codes are used to report, equipment, and devices provided to patients. A limited number of procedures not otherwise contained in the CPT system are also found here. HCPCS is alphanumeric and is administered by the Centers for Medicare and Medicaid Services (CMS) in cooperation with other third party payers. CMS includes levels in its Healthcare Common Procedures Coding System: HCPCS Level I is the coding system; HCPCS Level II is usually referred to as HCPCS codes, described above. 2

3 5/2/2014 Sample Page 1 of 2 Sample Page 2 of 2 Resource HCPCS Release & Code Sets Medical Necessity Diagnosis Coding: Classification of Diseases, Ninth Revision, Clinical Modification (ICD 9 CM) The National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications. For a service to be considered medically necessary, it be reasonable and necessary to diagnosis or treat a patient s medical condition When submitting claims for medical condition. When submitting claims for payment, the diagnosis codes reported with the service tells the payer " a service was performed. The diagnosis reported helps support the medical necessity of the procedure. Raemarie Jimenez, CPC coding can help prove medical necessity 3

4 5/2/2014 In order to code, you need to learn the guidelines Coding Scenarios 4

5 Modifiers: CPT versus Modifiers The Health Insurance Portability and Accountability Act (HIPAA) guidelines indicate that all codes and modifiers are to be standardized. Some coding and modifier information issued by CMS differs from the AMA s coding advice in the CPT manual; a clear understanding of payer s rules is necessary to assign such modifiers correctly. Modifiers Found in Appendix of CPT Also, the HCPCS Level II coding system has additional modifiers Modifiers from level may be applied to a procedure code. In other words, a CPT or HCPCS Level II modifier may be applied to a CPT or HCPCS Level II code. MODIFIERS Modifiers are character codes that add clarification and additional details to the procedure code s original description A code addendum that provides meaning to the original code. Types of Modifiers There are basically two types of modifiers: informational modifiers (those that affect payment) and modifiers (modifiers that affect reimbursement) It is important to read the complete descriptions of modifiers in CPT & HPCS MODIFIER BRIEF DESCRIPTION APPLICABLE SECTIONS 22 procedural services Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine 23 anesthesia Anesthesia 24 E/M service by the same physician or other qualified health care professional during a postoperative period Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service E/M E/M 5

6 modifiers/ Example of payer informatio n on modifier usage HCPCS Level II Modifier The HCPCS Level II codes are alphanumeric codes developed by as a complementary coding system to the AMA s CPT codes. Similar to the CPT coding system, HCPCS Level II codes contain modifiers that serve to further services and items without changing the meaning of the HCPCS Level II code with which they are reported. Using modifiers It is important to note that HCPCS Level II modifiers may be used in conjunction with codes, such as LT Tympanostomy (requiring insertion of ventilating tube), general anesthesia, ear. Likewise, CPT modifiers can be used when reporting HCPCS Level II codes, such as L Ankle contracture splint, (this scenario can also be reported with modifiers RT and LT, depending on the third party payer s protocol). Example of some HCPCS Modifiers Overview of National Correct Coding Initiative Edits More information will be covered in the next session Coding/Billing for General Surgery 101 6

7 National Correct Coding Initiative CMS developed the National Correct Coding Initiative (NCCI) to promote national coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. CMS developed its coding policies based on coding conventions defined in the AMA's Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. CMS updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits. Why use the NCCI Manual? coding and reporting of services are critical aspects of proper billing. Service denied based on NCCI code pair edits or MUEs may be billed to Medicare beneficiaries; a provider cannot utilize an Advance Beneficiary Notice of Noncoverage (ABN) to seek payment from a Medicare beneficiary. The NCCI tools found on the Centers for Medicare & Medicaid Services (CMS) website (including the National Correct Coding Initiative Policy Manual for Medicare Services ) help providers avoid coding and billing errors and subsequent payment denials. Reminder It is important to understand, however, that the NCCI does include possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code even if edits do not exist to prevent use of an inappropriate code combination. Should providers determine that claims have been incorrectly, they are responsible to contact their Medicare Administrative Contractor (MAC) about potential payment adjustments. Quarterly updates 7

8 More detail in next class Certification programs Our mission as a medical billing association is to provide industry and regulatory education, networking opportunities for our members, to be able to share information and ideas and to market our member's abilities and professional services as a group. Additional resources: AAPC certifications encompass the entire business side of provider care, with physician coding ( CPC ), the hospital outpatient facility ( CPC H ), payer perspective coding ( CPC P ), interventional radiology cardiovascular coding ( CIRCC ), medical auditing ( CPMA ), medical compliance ( CPCO ), and practice management ( CPPM ). Specialty coding credentials. No requirement to hold the CPC credential. 8

9 Registered Health Information Administrator (RHIA ) Registered Health Information Technician (RHIT ) AHIMA Coding Credentials The CCA, the CCS and the CCS P are the only coding credentials worldwide currently accredited by the National Commission for Certifying Agencies (NCCA). Certified Coding Associate (CCA) Certified Coding Specialist (CCS) Certified Coding Specialist Physician based (CCS P) AHIMA Specialty Certifications Certified Health Data Analyst (CHDA ) Certified in Healthcare Privacy and Security (CHPS ) Certified Documentation Improvement Practitioner (CDIP ) Certified in Healthcare Privacy and Security (CHPS ) Certified Healthcare Technology Specialist (CHTS) Association of Health Care Auditors and Educators Robin Linker is here! Ask her about AHCAE Certified Healthcare Chart Auditor (CHCA) Certified Healthcare Chart Auditor Facility (CHCAF) Certified Healthcare Chart Auditor Surgical (CHCAS) info.org/ Internationally Recognized Board Certifications. Certified in Healthcare Compliance (CHC) Certified in Healthcare Research Compliance (CHRC) Certified in Healthcare Privacy Compliance (CHPC) Certified in Healthcare Compliance Fellowship (CHC F) Certified Compliance and Ethics Professional (CCEP) Certified Compliance and Ethics Professional International (CCEP I) Certified Compliance and Ethics Professional Fellowship (CCEP F) Internet Resources 9