Try these easy networking tips for shy people.

Networking is high among conference attendees’ list of benefits. If your shyness might be preventing you from reaching out to fellow medical coders, pull yourself out of that corner and try these networking tips:

• Realize that you’re not the only one who’s shy. Even big executives can be shy people. The next time you’re at a coding conference event, scan the room for someone standing by herself. If she were an outgoing person, she would probably be mingling. Chances are, she’s a shy person who’s waiting for someone to come talk to her. Take the opportunity.
• Enlist your extroverted friends’ help. Stick around your more outgoing coworkers at conference events and meetings, and get them to introduce you to fellow coders or coding consultants. They can help you start the conversation and back you up during moments of silence.
• Practice networking skills at your next family reunion. Chances are, there are many members of your family who you don’t know well. Think of your family reunion as a conference. Walk over and introduce yourself to your family members who you don’t know very well and strike up a conversation with them.

You’ll build your skills to do that at your next coding conference.

• Find ways to have people come to you. Volunteer to be a greeter at the next big meeting or conference. Attendees can just come straight to you. All you have to do is start the conversation.
• Look for ways to break out of your shell a little. Constantly look for ways to build your conversational skills. Read up on the subject, and strike up a conversation at work with coders you don’t know that well. Pop culture, anyone? The opportunities are out there — you just need to grab them.

Be a medical coding hero: Sign up at Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Where in the world is Supercoder Girl? Twitter: @supercodergirl Facebook: http://www.facebook.com/supercodergirl

Laureen’s tips will have turn that clock from foe into friend.

We’ve all been there: the test, the paper, the ticking of that pesky clock. When it comes to the CPC exam, time management is of the utmost importance, because if you don’t allot your time appropriately then all that studying will go to waste.

Guest columnist, Laureen Jandroep, OTR, CPC, CPCEMS, CPC-H, a CodeRyte coding analyst and senior instructor for New Jersey-based www.CodingCertification.org, has the solution.

Follow These Laureen’s Advice for Timed Success:

I’ve been teaching medical coding since 1999 and many students that have come to my review class have said they took a course, attended a boot camp etc. and still did not pass the exam. For those students it is no longer a matter of studying – it is about how they take the test.

For the CPC exam, sponsored by the American Academy of Professional Coders (AAPC), it is divided in three sections. You need to pass each section to pass the entire exam. So you could go really slow in the beginning and ace the first section, pass the second section but due to running out of time fail the third section. The exam is pass/fail – not about getting an A. So you need to spread your success and pass each section.

One Hour – Two Hour Method

When you open your exam you’ll find an answer grid with three columns containing 50 questions each. Allow yourself an hour for each column – two hours for the one with the surgery questions. So that will be four hours of the 5.5 hour exam. You can ask the proctor to announce as each hour elapses.

So when hour one is over and the announcement is made you finish the question you are on and move to the next column – so question 51. Yes, you will have unanswered questions in column one – that is ok – you will go back. The idea is to spread your success across each section. When four hours has elapsed take a deep breath and scan your answer grid – which column has the most unanswered questions? Spend time on that column first and spread your remaining time accordingly on you unanswered questions. This method will improve your chances of having enough correctly answered questions in each section.

One Dot – Two Dot Method

Answering an easy peasy medical terminology question carries as much weight as a time consuming surgical question. In addition to the above method you can rate questions you’ve started to answer but decided to leave them for later and answer easier questions first. In the margin of your exam grid put two dots if you feel it is a very hard time consuming question, one dot for a medium difficulty one. Now when you have your last hour and a half you can go right to the one dots – leaving to two dots for absolute last.

Don’t Leave Any Questions Unanswered

Use the last 20 minutes to guess at an answer on any unanswered questions. You have a 25% chance of getting it right without even looking at the question. Of course if you’ve looked at the question and thrown out an answer or two indicate that on your answer grid so now you may have a 50/50 chance of getting the answer right.

– Thanks to guest columnist, Laureen Jandroep, OTR, CPC, CPCEMS, CPC-H, a CodeRyte coding analyst and senior instructor for New Jersey-based www.CodingCertification.org!

Be a medical coding hero: Sign up at Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

Where in the world is Supercoder Girl? Twitter: @supercodergirl Facebook: http://www.facebook.com/supercodergirl

It’s your worst nightmare: Not only are you forced to recall poor fashion choices of the past, but you’re facing an audit. Maybe the headband had you thinking that you could bill a consult, but you know what the difference is now that Medicare no longer pays for these services. But ‘now‘ doesn’t mean a lot to an auditor.

Bottom line: If an auditor comes calling and wants to review your consult notes, he will be judging you based on the Medicare rules as of the date of service.

Some coders assume that any audits taking place in 2010 or thereafter that involve consult notes will be based on CPT consult rules, and not Medicare’s, since Medicare does not recognize consult payment as of 2010. Because Medicare’s consult regulations were generally more strict than CPT’s, practices consider this a small victory. But this is inaccurate, experts say.

“If the auditor is reviewing services you performed in 2009, CMS rules from 2009 will apply,” confirms Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC with CRN Health-care Solutions in Tinton Falls, NJ. “In 2006, Medicare changed the rules — so if they audited 2005 consult services, it would be a different standard than 2009 services as well,” she says.

Requests for Notes May Follow

The Medicare auditor may not just want to read your physician’s notes, but may even request notes from other practitioners if it’s necessary to back up your claims.

“In evaluating consults, I have even experienced one audit where they also requested the referring physician’s documentation to substantiate the reason for the consult,” says Devona Slater, CHC, CMCP, president and compliance auditor with Auditing for Compliance and Education Inc. in Leawood, Kan.

“Medicare’s definition of a consult and the CPT definition have always been different and a reason for confusion,” Slater says.

Slater says she has seen auditors who find that practices don’t have adequate consult documentation “downcode the consults to new or established patient visits and request a refund for the difference.”

Be a hero. Sign up for Supercoder.com.

We show you answer choices that you can quickly identify as ‘wrong, wrong, dead wrong

If studying for the lesion destruction questions on the Certified Professional Coder exam is well, destroying YOU, help is here! We’ve got ways to apply our savvy test-taking tips to lesion destruction questions.

Tip #1: Watch out for those little words that mean the difference between a right and wrong answer. We’ve been talking about words like that a lot lately, and in the world of lesion destruction coding, these words are ‘premalignant’ and ‘benign.’

CPT’s descriptors for 17000-17004 make them apply only to premalignant lesions. Similarly, you should reserve 17110 and 17111 for benign lesions other than skin tags or cutaneous vascular proliferative lesions.

Tip #2: Make the most of ‘open book’ by marking up the lesion destruction coding section as you study. Here’s why …

Guidelines for assigning code units for premalignant and benign lesions differ, so be sure you read the code descriptors carefully as you study and mark those crucial differences.

Tip #3: Learn how to spot the wrong, wrong, dead wrong answers to lesion destruction coding questions.

If you see answer these answer choices for a coding scenario, you can quickly strike them out as wrong, wrong dead wrong:

A. 17000, 17004

B. +17003, 17004

Reason: You should report a single unit of 17000 for the first premalignant lesion the physician destroys. You would then apply a single unit of +17003 for each of the second through 14th lesions. But if the physician removes 15 or more lesions, you would report only 17004. You would never report 17000 and 17004 or +17003 and 17004 during the same session.

Example 1: The surgeon destroys 13 premalignant lesions. In this case you would report 17000 (for the initial lesion) and +17003 x 12 (one unit each for each for the 12 additional lesions).

Example 2: The surgeon destroys 19 premalignant lesions. In this case you would report 17004 only.

Tip #4: Simplify your test taking and note that size doesn’t matter when assigning codes for benign or premalignant lesions. Only the number of lesions – not the lesion size – matters. In other words, destruction of 10 big lesions codes out the same as destruction of 10 small lesions.

Time-Saving Tip: If you’re trudging through an op note on the exam, you can disregard size info as unimportant if you confirm you’re working with benign or premalignant lesions.

Adapted from Supercoder.com. Get access to valuable CPC exam study guides when you sign up for a free trial.

Think you know OB coding because you’ve done it before? Here’s one crucial difference between real life and the CPC exam.

Warning: Your previous coding or billing experience can actually lead you astray on some CPC exam questions. So when you’re preparing for your test, read and mark your CPT manual as if you were a babe in the woods.

On the Certified Professional Coder exam, you should answer questions based on guidelines in your CPT and ICD-9 manuals only. That can be difficult if you’re used to scoring reimbursement from insurers that ask you to disregard guidelines in the manual.

Mark this place in the Maternity Care & Delivery section of your CPT manual where coding guidelines may differ from the payer rules you deal with in your everyday coding job.

Antepartum ultrasounds: Although many insurance providers include ultrasounds (76801-76802 or 76805-76810) as a standard part of the ob global package (for example, 59400,Routine obstetric care including antepartum care, vaginal delivery [with or with episiotomy, and/or forceps] and postpartum care), CPT maintains otherwise.

“Antepartum care includes the initial and subsequent history, physical examinations, recording of weight, blood pressures, fetal heart tones, routine chemical urinalysis, and monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery,” CPT states in the guidelines at the beginning of its Maternity Care & Delivery section. “Any other visits or services within this time period should be coded separately.”

Want to go for your COBGC™? Learn more here.

You may not notice these little habits that can trash your career.

If you’re a medical coder who’s lucky enough to work from home, you may attend training sessions via teleconference. And, even if you work in an office you might teleconference with colleagues on other sites to discuss audits, EMR purchasing decisions or a host of other topics.

Pitfall: When you’re in a face-to-face meeting, it’s easy to stay professional and be on your best behavior. However, when you’re in your cube listening to a call, you may slip into some bad manners that can damage how your colleagues and bosses perceive you. Follow these tips from www.effectivemeetings.com to boost your etiquette and ensure a better meeting for everyone:

♦ Be on time! Nobody wants to hang around on the phone waiting for a latecommer.

♦ When you’re leading the meeting, take a roll call at the beginning to find out who is present. This will let everyone in the meeting know who’s attending, who’s on the line and who you’re waiting for.
If the group is small and doesn’t meet regularly, give everyone a chance to introduce himself and explain why he’s at the meeting.

♦ If you come into a conference call late, don’t interject into the discussion. Wait until a break in the conversation occurs and then introduce yourself.

♦ Make it a rule for everyone to identify themselves before they speak. If the people in the meeting don’t know each other, they won’t be able to tell who is speaking from voice alone.

♦ If certain people are doing all the talking in your meeting, encourage the more quiet members to give their input.

And here are a couple extra tips from a lady who’s made career limiting moves on more than one teleconference call.

♦ If you’re not speaking, mute your phone — especially if it’s a cell or a VOIP. Muting your end makes the line clearer and helps everyone on the call understand who’s speaking. Plus, muting your phone when you’re not speaking assures no one will hear your loud guffaws, your loud eating or slurpy drinking, or that crass coworker who’s suddenly pops into your cube to make a ‘joke.’

♦ Word to the wise: Even if your phone is on mute, act as if it’s live. I don’t know about you, but my teleconference lines have this mysterious way of unmuting themselves so that I trash my career. The nightmare? A coworker pops by, asks what I’m doing and I say “Listening to some moron drone on and on,” and my phone is not on mute. I’ve inadvertently announced my opinion to all teleconference attendees. Yikes!

Parts of this article adapted from Successful Supervisor.

Here’s a nuts-and-bolts guide to the E/M section in your CPT maual.

If you’re a lab, pathology, or radiology coder, the evaluation and management questions may have you re-evaluating whether you want to take the test in the first place. Relax. My Coding Career is here to help, and this post is designed to school you in the basics.

Tip: For more CPC exam prep help with E/M coding, check out this E/M coding lingo page, as well as posts about particular E/M issues like ‘time.’ Don’t see something you need to prepare for the CPC exam? Write us here at My Coding Career.

Open-Book Test Tip: As you study for the exam’s E/M questions, keep your CPT manual book open and mark important points. If you’re very familiar with what’s in your CPT manual, your odds of discovering the correct answer in your book are higher.

How Your CPT Manual Organizes E/M Codes

CPT divides E/M services into visits and consultations. These categories are further divided — office visits into new or established patients; hospital visits into initial and subsequent; and consultations into outpatient and inpatient. CPT further divides such categories and subcategories based on the type and place of service and the patient’s status.

Note: Even though Medicare no longer accepts consultation codes in 2010, some private payers do accept them and they are still in your CPT manual. So, focus on the E/M guidelines in your CPT manual to answer test questions.

CPT uses the same basic format to describe the E/M service levels for most categories:

1. listing a unique code;
2. specifying the place and/or type of service; for example, an outpatient consultation;
3. defining the services content; for example, a comprehensive history, comprehensive examination and moderate medical decision-making;
4. describing the nature of the presenting problem(s) usually associated with a given level; and
5. specifying the time typically associated with the service.

Levels of E/M Service

There are three to five E/M service levels available for reporting purposes within each E/M code category or subcategory. Levels of E/M services are not interchangeable among the different categories or subcategories. For example, the first level of E/M services for a new patient office visit does not have the same definition as the first level of E/M services for an established patient office visit.

The descriptors for the E/M service levels recognize seven components, six of which CPT uses in defining the E/M levels. These components are:

1. history
2. examination
3. medical decision-making
4. counseling
5. coordination of care
6. nature of presenting problem
7. time.

The first three of these components (history, examination and medical decision-making) are considered the key components when selecting an E/M service level.

The next three components (counseling, coordination of care and the nature of the presenting problem) are considered contributory factors in most encounters. Although the first two of these contributory factors are important E/M services, the healthcare provider doesn’t need to provide them at every patient encounter.

The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the E/M service levels. You may separately report your physician’s performance of diagnostic tests/studies for which specific CPT codes are available, in addition to the appropriate E/M code. In addition, you may separately report the physicians interpretation of diagnostic tests/studies results with preparation of a separate distinctly identifiable signed written report using the appropriate CPT code with modifier 26 (Professional component).

Commonly Used E/M Terms

When you’re reviewing E/M rules and regulations, there are certain terms that you’ll see frequently, including the following:

Adapted from the E/M Coding Survival Guide. Use the complete guide to study for the exam when you sign up for Supercoder.

Already an E/M whiz? Get your CEMC.

Image: Yassine Mrabet, Wikimedia Commons

This handy glossary helps you ace terminology questions on the CPC exam.

When coding diagnostic radiology, it’s very important to understand what position the patient was in and what kind of view was taken.

Understanding body planes, views and positions will also help you with questions in other sections of the Certified Professional Coder exam, such as Anatomy and Terminology & Surgical Coding.

Example: When coding some kinds of surgeries a mention in the op note indicating whether the patient was ‘prone’ or ’supine’ can help you discern the approach the surgeon was taking and select the proper code.

The different planes for radiological services include:

Coronal (frontal): This is the vertical plane dividing the body into front and back sections

Sagittal: This vertical plane divides the body into equal left and right sections

Transverse: This horizontal plane divides the body into top and bottom sections.

Open-Book Test Tip: The diagrams at the very beginning of your CPT manual contain labeled illustrations of the planes of the body.

Views you’ll see radiologists document include the following:

Anteroposterior (AP): front to back

Apical: chest including lung apex to minimize the rib image overlapping a lung lesion

Bucky: film placed in a device that eliminates secondary radiation

Decubitus (DEC): lying on side

LAO (left anterior oblique): left front

LPO (left posterior oblique): left rear

Oblique: angled view

Odontoid: open-mouth cervical spine view to identify joint space C1

Posteroanterior (PA): back to front

RAO (right anterior oblique): right front

RPO (right posterior oblique): right rear

Stereo: two views of a structure, one at 90 degrees to the film and second with tube angled 12 degrees to 15 degrees toward the head

Swimmer’s: thoracic x-ray with one or both arms over head.

You may also see directions and positions such as the following:

Anterior (ventral): front

Distal: farthest away from center

Inferior: below

Lateral: side

Medial: middle

Posterior (dorsal): back

Prone: face down or palm down

Proximal: nearest to the center

Superior: above

Supine: face up or palm up

There’s a CPC exam training camp coming soon to a city near you!

Take a few minutes to digest some digestive system ICD-9 coding tips.

Today, we’re going to review some of the diseases and conditions that can crop up in questions about the digestive system on the CPC exam.

Test Prep Tip: As you read this post, open up the ICD-9 manual you plan to use in the open-book exam and mark it.

Cholecystitis / Colitis

Don’t confuse these two medical terminology ‘dopplegangers’ — words that look so similar they could trip you up if you’re not careful.

Cholecystitis (575.xx) is inflammation of the gallbladder, which often accompanies cholelithiasis (gall stones, 574.xx). Symptoms include right upper quadrant pain and tenderness, sometimes accompanied by fever, chills, nausea and vomiting.

Colitis (556.x) is ulcerative inflammation of the mucosa lining the colon. The most common symptom is bloody diarrhea, and other symptoms include abdominal pain or tenderness, fever, and swelling or redness of the colon tissue. To diagnose colitis, the physician may administer x-rays, stool tests, sigmoidoscopy or colonoscopy. Treatments include antibiotic therapy or, in some cases, surgery.

Pseudomembraneous colitis (008.45) is the result of infection, usually by a bacterium called Clostridium difficile. People who have been on certain antibiotics, the elderly, and diabetics are particularly susceptible to this kind of infectious colitis.

Two more dopplegangers: diverticulitis / diverticulosis

Diverticulosis is the simple presence of diverticula, and approximately 80 percent of patients don’t know they have it. Diverticulitis happens when the diverticula get inflamed, and it’s more likely to cause symptoms.

Open Book Tip: In your code book, underline the ends of these ‘doppleganger’ words when they appear so you can be sure you’re paying attention to the difference when you’re looking them up.

To code colonic polyps correctly, you need 3 pieces of information

Colonic polyps are growths of tissue that protrude from the bowel wall into the lumen. Some are neoplastic, which means abnormal growth has occurred, and there is potential for malignancy. Some are non-neoplastic, which means that the growth consists of normal tissue with little or no potential for malignancy.

Test Taker’s Tips: When answering a test question that asks you to select the correct diagnosis code for a polyp, you must know:

• The polyp’s location: For malignant primary neoplastic polyps in the colon, documentation must indicate the specific colon site (ascending, transverse, descending, sigmoid). For all other behaviors, the code descriptors refer to the colon, large intestine or digestive system.
• The polyp’s behavior and capacity to spread: Benign (noncancerous) and malignant (cancerous) are two types of behavior. In addition, a colonic polyp could be classified as uncertain (235.2), which means further investigation is necessary to determine whether the polyp is malignant. It could also be unspecified (239.0), which means that lab tests are necessary to determine the polyp’s behavior.
• Whether the malignancy is primary, secondary or in situ: A primary malignant colonic polyp (153.0-154.8) is one in which the colon is the original site of the cancer. A secondary malignant colonic polyp (197.5) is one in which the cancer has metastasized from another site to the colon. An in situ malignant colonic polyp (230.3-230.4) is one in which the cancer is confined to the colon.

Open Book Test Taking Tip: Once you’ve found the diagnosis code in the neoplasm table, verify it in the Tabular List (Volume 1) of the manual. The code descriptions in the tabular list help identify which colon sites the codes cover. A benign polyp in the rectosigmoid junction, for example, should be reported not as a benign polyp of the colon, but as a benign polyp of the rectum (211.4) — even though the rectosigmoid junction is often lumped together with the colon in other ICD-9 descriptions.

Esophagitis

Esophagitis is inflammation of the esophagus that occurs because of acid reflux (530.11), because of infection (especially in patients with compromised immune systems), or because the patient has swallowed harmful chemicals.

Test Taking Tip: Pay attention when you see the words acute or chronic on the CPC exam; they often your affect code choice, and can help you eliminate incorrect choices. In acute esophagitis (530.12), the tissue is actively inflamed. Chronic esophagitis means that the tissue has been inflamed in the past but is not now. There is no specific code for chronic esophagitis, and it has been lumped in the catchall category of ‘unspecified’ (530.10). It’s possible for a patient to have both acute and chronic esophagitis if two parts of the esophagus were biopsied and one is actively inflamed while the other is not.

Illustration: WikipedianProlific

Hemorrhoids

A hemorrhoid (455.0-455.9) is a dilated vein of the lower rectum. Symptoms include pain and bleeding.

Surgeons may employ various treatment methods for hemorrhoids, depending upon their exact location and nature. Often they will refer the patient to a colorectal specialist or surgeon for treatment.

Test Taker’s Tip: Pay close attention to whether test questions mention ‘internal‘ or ‘external‘ hemorroids, because that will affect your choice of both ICD-9 codes and CPT codes.

What CPC exam topics would you like us to review on My Coding Career next? Leave a comment in the comment area and let us know!

Study and mark these key radiology guidelines in your CPT manual.

I don’t know about you, but I absolutely dreaded the radiology questions on the Certified Professional Coder exam. And even though I passed the test, I’m certain I got a fair number of them incorrect.

I want to spare you the brain pain, aspiring CPCs. So over the next few weeks, I’ll be covering some radiology coding basics to help you prepare for the big test.

Test Taker’s Tip: With your handy highlighter in hand, take a look at the guidelines at the beginning of your CPT manual’s Radiology chapter (70000 range). Be sure to read and mark these 2 important points.

1. Radiological Supervision and Interpretation

The guidelines state that radiological supervision and interpretation describes the radiologic portion of a procedure. You may see this referred to as RS&I or S&I.

If a single physician, such as the radiologist, performs the procedure as well as the imaging supervision and interpretation, you may report both separately.

For example, if the radiologist performs percutaneous drainage of a peritoneal abscess with guidance, you may report the following:

• RS&I: 75989 (Radiologic guidance [i.e., fluoroscopy, ultrasound or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiologic supervision and interpretation)
• Procedure: 49021 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous).

2. Administration of Contrast

Several radiology code descriptors include the term with contrast. CPT guidelines clarify that only contrast material administered intravascularly, intra-articularly, or intrathecally qualifies as with contrast for these codes.

In other words, if the contrast is oral, rectal, or both, you should not choose a code that states with contrast.

Next week in My Coding Career: It’s a view! It’s a plane! It’s a what? We teach you what you need to know to understand how the patient was placed and where exactly that beam went. Beam me up, Scotty.

You don’t have to go it alone for your CPC exam review. There’s a training camp coming to a location near you.