Session Number: 0598-000234 Session Title: Tactics for Including Medical Billing in the Curriculum Linda Martino, PA-C, CMPE Stephanie Maclary, RN, MHS, PA-C
Agenda! Objectives! Background (5-10 minutes)! Five Coding Discussion Items (30 minutes) Each Item will be presented individually with our current method/ideas Each small group will discuss and list their current method/ideas Each small group will present their method/ideas to the whole group We will keep track of each items method/ideas! Conclusion (5-10 minutes) Example slides
I. Objectives! Discuss and share various approaches in teaching medical billing! Identify and discuss obstacles in teaching medical billing! Discuss and share resources involved in teaching medical billing
II. Background! Why teach coding? Practitioners are responsible for coding Documentation is critical for BOTH diagnosis and procedural coding As we move toward a value based payment system correct coding is important Coding impacts reimbursement Auditing Be alert to possible fraud and liability if billed with your NPI (National Provider Number)
II. Background! How to teach coding Basics ICD 9/10 (International Classification of Diseases) Procedural (CPT, Current Procedural Terminology) Focus on documentation! When to teach coding Introduce in the didactic year Reinforce during clinical year
II. Background! Focus on Documentation Anatomic/Disease specific requirements Heart failure: CHF, Acute/Chronic, Left/Right failure or b o t h. Laterality: If any diagnosis could be right, left, or bilateral, t h i s M U S T b e n o t e d o r t h e c o d e w i l l b e a u t o m a t i c a l l y r e j e c t e d. Acute vs. chronic needs to be noted. e.g. Acute Uncomplicated Sigmoid Diverticulitis. Diverticulitis no longer works--> Automatic denial from payers Fractures: Name bone, degree of angulation, open or closed
II. Background! Focus on Documentation! Anatomic/Disease specific requirements Heart failure: CHF, Acute/Chronic, Left/Right failure or both. Laterality: If any diagnosis could be right, left, or bilateral, this MUST be noted or the code will be automatically rejected. Acute vs. chronic needs to be noted. Use: Acute Uncomplicated Sigmoid Diverticulitis. Diverticulitis no longer works! Automatic denial from payers Fractures: Name bone, degree of angulation, open or closed
III. Five Coding Discussion Items! Describe and share current tactics for teaching ICD 9/10 coding! Describe and share current tactics for teaching procedural coding! Describe and share current tactics for teaching electronic health records with respect to coding! Identify and discuss obstacles in teaching coding! Discuss and share resources used in teaching coding
III. Five Discussion Items! Describe and share current tactics for teaching ICD 9/10 coding (5 minutes) Consider When it is taught? Is it a separate module? Do you use outside experts?
III. Five Discussion Items! Describe and share current tactics for teaching procedure coding (5 minutes) Consider Do you use the same approach as in diagnosis coding? If not, what is different? When it is taught? Is it a separate module? Do you use outside experts?
III. Five Discussion Items! Describe and share current tactics for teaching electronic health records with respect to coding (5 minutes) Coding is embedded in the Electronic Medical Record software but selection of codes vary. Providers are responsible for their choices. Do you teach coding on a specific Electronic Medical Record software? If so is it hands on?
III. Five Discussion Items! Identify and discuss obstacles in teaching coding (5 minutes) Consider Locating information/expertise Fitting it in the tight curriculum Modifying to meet basic needs How do we make sure each student gets it? Experience of faculty teaching billing/coding
III. Five Discussion Items Discuss and share resources (5 minutes/4 slides) https://www.aapa.org/icd10_lp.aspx? utm_source=pacentral_nonmember&utm_medium=emai l&utm_campaign=icd10 AAPA ICD-10 Resource Have students participate in a hands on exercise to appreciate the differences in billing/reimbursement Review changes once per quarter to optimize revenue
III. Five Discussion Items Discuss and share resources CMS ICD-10 Coding Resources Fact sheet Coding guidelines Specialty tailored documentation and coding CMS ICD-10 Code Lookup feature Free and low cost smartphone apps https://www.cms.gov/medicare/coding/icd10/icd-10- Coding-Resources.pdf CMS E & M coding https://www.cms.gov/outreach-and-education/medicare- Learning-Network-MLN/MLNEdWebGuide/EMDOC.html
III. Five Discussion Items Discuss and share resources For ICD-10 and Evaluation and Management coding information http://www.roadto10.org/ Specialty guides, medical cases ICD-10 http://www.cms.gov/medicare/coding/icd10/2016-icd-10-cm-and- GEMs.html ICD-10 code set https://www.cms.gov/outreach-and-education/medicare-learning- Network-MLN/MLNEdWebGuide/EMDOC.html E & M coding Medical Managers Group Association, for local state chapter information and local coding expertise Phone: 303.799.1111 Toll-free: 877.ASK.MGMA (275.6462)
III. Five Discussion Items Discuss and share resources Medical Managers Group Association, for local state chapter information and local coding expertise Phone: 877.ASK.MGMA (275.6462) Speaker: Betsy Nicoletti, M.S., CPC
IV. Conclusion! Review of points shared! Ideas for future discussion! Example slides, follow
IV. Conclusion! Example Introduction to ICD-10 ICD-10-CM! Are 3 7 digits;! Digit 1 is alpha;! Digit 2 is numeric;! Digits 3 7 are alpha or numeric (alpha characters are not case sensitive); and! A decimal is used after the third character. Examples:! A78 Q fever;! A69.21 Meningitis due to Lyme disease; and! S52.131A Displaced fracture of neck of right radius, initial encounter for closed fracture.
IV. Conclusion! Example slides for Introduction to ICD-10 Code Structure 1 st -3 rd digits are the category 4 th 6 th subdivide category Etiology, Anatomical site, Severity 7 th gives characteristics: initial (A) or subsequent encounter (D) or sequela (late effects) (S)
IV. Conclusion! Example slides for Introduction to ICD-10! N83.0 Follicular cyst of ovary! N83.1 Corpus luteum cyst! N83.29 Other ovarian cysts! N83.31 Acquired atrophy of ovary! N83.32 Acquired atrophy of fallopian tube! N83.33 Acquired atrophy of ovary and fallopian tube! N83.51 Torsion of ovary and ovarian pedicle! N83.52 Torsion of fallopian tube! N83.53 Torsion of ovary, ovarian pedicle and fallopian tube
IV. Conclusion Example slides for CPT Evaluation and Management coding Three KEY Components History Exam Medical Decision Making Four Contributing Components Counseling Coordination of Care Nature of Presenting Problem Time
IV. Conclusion! Example slides for CPT Evaluation and Management coding! 99212/Problem focused: OV for 11 y/o, estab. Pt. seen in f/u for mild acne of the cheeks on topical agent (10 min)! 99213/ Expanded problem focused: OV for 70 y/o DM HTN estab. Pt. with recent change in insulin requirement (15 min)! 99214/ Detailed: OV for 32 y/o estab. Pt with new onset R lower quadrant pain (25 min)! 99215/ Comprehensive: OV for estab. Pt. with Kaposi s sarcoma who presents with fever and widespread vesicles (40 min)
IV. Conclusion! Please write down your contact information or leave your business card if you would like a compilation of today s presentations methods and ideas! Thank you