May 2007

Medicare to allow up to 8 Diagnosis Codes Per Claim
Coding Expert Margie Vaught Joins DecisionHealth
E/M Tip of the Month
Take Your Exam Online
Upcoming Events

Hello from the Board of Medical Specialty Coding and Compliance! We hope you enjoy your monthly ezine and find the information useful. If you have any comments or recommendations for future issues, please contact me through the following channels:

Victoria Forlini, Executive Director
vforlini@medicalspecialtycoding.com
301/287-2250 (phone)
301/287-2941 (fax)

Medicare to allow up to 8 diagnosis codes per claim

Prepare to start using up to eight diagnosis codes per Medicare claim – both paper and electronic – starting July 1.

The upshot for your practice: Using more ICD-9-CM codes on your claims could increase reimbursement by helping prove medical necessity for higher level E/M codes and procedures. Moreover, it provides you with more sophisticated data about the patients seen in your practice.

The format for your electronic claims, the ANSI837P 4010A, already allows you to enter up to eight diagnosis codes. But Medicare currently only processes the first four; the rest aren’t used in payment determinations. That will change July 1 when Medicare will begin considering all diagnosis codes on the claims.

Entering more diagnosis codes will help specialties such as gastroenterology that commonly see secondary conditions affect patient care. Although GI physicians typically see a limited number of conditions, it’s common to have secondary conditions impact the diagnosis codes.

Remember, too, that there are diagnoses that cannot be re-ported with just one code.

Unlike CPT® codes, ICD-9-CM codes aren’t directly tied to payment amounts and therefore often are overlooked. But don’t make that mistake: the wrong diagnosis code could mean you don’t get paid at all if a claim is denied.

Expanded diagnosis codes also help justify medical necessity. Example: a diabetic patient presents for abdominal pain and the physician runs a blood sugar test. Without the additional diabetes diagnosis, it’s hard to explain why a patient with abdominal pain is getting a blood sugar test.

Another example: A patient with problems such as hypertension, chronic obstructive pulmonary disease (COPD) or asthma presents with chronic diarrhea. The chronic conditions very well may affect how the physician treats the patient. In fact, those conditions may be causing the symptom the patient wants your pro-vide to treat. For instance, medications for those problems may be causing the diarrhea. The additional diagnosis codes can help justify a higher-level E/M service.

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Coding Expert Margie Scalley Vaught joins DecisionHealth

DecisionHealth, publisher of ICD-9/CPT Coding Pro, the Coder's Pink Sheets and other healthcare coding, compliance and reimbursement newsletters, is pleased to announce medical coding veteran and industry-leading consultant Margie Scalley Vaught has been named the company's Coding Content Specialist .

Vaught, who holds professional credentials as CPC, CPC-H, CCS-P, MCS-P, PCE, ACS-OR and ACS-EM, has coached thousands of advanced coding professional, as well as those just beginning their careers in this growing field. She has been a featured speaker for the coding and physician practice industries' largest professional associations, top specialty-specific medical societies and various medical information publishers.

Among her responsibilities in this new role, Vaught will author a host of products designed to ensure accurate, efficient and complete coding and billing among physician office coders, billers and physicians, and continue in her advisory role for the Board of Medical Specialty Coding and Compliance. Vaught will continue to offer consulting, auditing and on-site education services to physician practices.

She will carry out her DecisionHealth responsibilities from her home in Washington state, where she resides with her husband and four children.

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E/M Tip of the Month
Test your E/M coding skills by identifying the answer to this question:

May diagnostic or therapeutic services be performed in conjunction with a consultation?

Find out the answer at the bottom of this email newsletter. Also check this space monthly for the E/M Tip of the month.

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Take Your ACS or SCP Exam Online

To make test-taking easier for you, you can now take the ACS and SCP certifications and ACS recertification exams online. It's simple! Register as you normally would -- via our website or on paper, and select the Online option. We will send you an email confirming your registration and giving you further instructions. Don't worry! You still can take the exam at a conference, but we're listening to you as you search for easier ways to become certified.

Visit us at www.medicalspecialtycoding.com for more information.

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Upcoming Events

Here's the 411 on some upcoming events where you'll get top-notch educational opportunities to earn CEUs and even a place to sit for your specialty certification or recertification exam!

Conference of the Month:

Anesthesia Billing, Coding and Compliance
June 11-13 in Charleston, South Carolina

Cuts in Medicare’s anesthesia conversion factor, ASA and CPT code revisions and changes in private-payer policies make it more important than ever to produce exceptionally accurate coding and conduct thorough billing.

Elevate your anesthesia coding knowledge to the highest level at this one-of-a-kind educational conference. Spaces are filling up fast to hear these fabulous speakers:

Devona Slater	Joanne Mehmert	Samantha Mullins	Kelly Dennis

To register or to learn more information, visit:
www.specialtyconferences.com/anesthesia2007/

Check out more in-person and audio conference opportunities:

Event: Tackle Knee Coding Problems to Smooth Payment
Date: May 22, 2007
To register or to learn more information:
www.decisionhealth.com/conferences/A1145/register.html

Event: Major Gynecological Procedures: Sharpen Your Coding Skills for TAHs, Conizations, Colporrhaphies & Other Surgical Services
Date: May 23, 2007
To register or to learn more information:
www.decisionhealth.com/conferences/A1216/register.html

Event: The New CMS-1500: See Through the Confusion, Learn the Changes and Where to Put Your NPIs
Date: June 7, 2007
To register or learn more information:
http://www.decisionhealth.com/conferences/A1264/home.html

Event: Power Up Your Chart Audit Program
Date: June 7, 2007
To register or learn more information:
http://www.decisionhealth.com/conferences/A1237/home.html

Event: Prepare Now for 2008 ICD-9 Diagnosis Codes
Date: June 12, 2007
To register or learn more information:
http://www.decisionhealth.com/conferences/A1246/home.html

Event: Anesthesia Billing, Coding and Compliance
Date: June 11-13, 2007
To register or to learn more information:
www.specialtyconferences.com/anesthesia2007/

Event: Interventional Procedure Coding -- Take It to the Next Level
Date: June 14-15, 2007
To register or to learn more information:
www.specialtyconferences.com/interventional2007/

Event: Advanced Orthopedic Symposium
Date: July 18-20, 2007
To register or to learn more information:
www.specialtyconferences.com/ortho2007/index.html

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Answer to the E/M Tip of the Month is..

Yes. They may be initiated at the initial consultation service or follow-up visits. Ongoing management following the initial consultation service must be reported using the subsequent care visit codes for the approrpriate place of service. In the office setting, that would be established patient codes 99212-99215. In the hospital setting, use subsequent hospital care codes 99231-99233.

Source: http://www.cms.hhs.gov/MLNMattersArticles/
downloads/MM4215.pdf