Monday, December 10th
Medicare News: Payment System, Quality Reporting
Presenter: Gina Throneberry, RN, MBA, CASC, CNOR
8:15am-9:00am
This presentation includes a review of CMS updates for 2013 to include news from Washington. Quality measure reporting requirements will be reiterated to include the history and “when” to report the G codes for Medicare claims.
CPT Coding Update for 2013- Money Makers & Money Breakers
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
9:00am-10:00am
This presentation includes an update on new, revised, and deleted CPT and HCPCS codes. It will include applications and scenarios for reporting the new CPT codes as well as reimbursement potentials from a CMS perspective. A review of CMS payment indicators, multiple procedure reporting guidelines, and general billing guidelines will also be addressed during this session to assist in the coders understanding of “if” and “how” a procedure will be reimbursed.
Top ASC Coding Mistakes That Impact Your Bottomline
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
10:15am-12:00pm
Not sure your ASC facility is reporting its multi-specialty procedures as accurately as possible? Understanding the top coding mistakes made in ASC facilities in the areas of orthopaedics, pain management, GI, ENT, and Ophthalmology is a stepping stone to accurately reporting your procedures going forward. Receive specific coding directives from the AMA, CMS, and specialty societies as well as everyday coding tips for reporting so your facility doesn't leave money on the table.
Documentation Deficiencies in Your ASC: Why Change Now?
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
1:00pm-2:00pm
How often do your ASC coding selections differ from the physician's code selections due to documentation questions and/or deficiencies? Deficient documentation could result in erroneous payments, reimbursement delays or denials. Learn the " how, what, when, and whys" to the query process, the financial impact when questionable operative documentation is not clarified, as well as review samples of correct versus incorrect physician queries.
External Audits: Establishing Protocols
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
2:00pm-2:45pm
Whether your ASC is in the process of establishing or it has established an external audit program, this is a presentation not to be missed. Your company audit protocol should define the purpose of the audit, frequency of review, and sample size. This presentation discusses selecting a credible auditing company as well as establishing accuracy goals and problem resolution when goals aren’t met.
Best Business Office Practices: Dos and Don’ts
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
3:00pm-4:00pm
Would your ASC facility pass an internal business office audit of its daily functions? This session will provide tips of the trade to ensure your facility isn't tempting fate! Areas of discussion include checks/balances of job duties, denials and collections tracking, the patient accounting system, precertification/verification, payment posting, carrier contract grids, and electronic billing follow-up.
Tips for Keeping Up with Coding Directives While Controlling Costs
Presenter: Cristina Bentin, CCS-P, CPC-H, CMA
4:00pm-5:00pm
Learn about the valuable resources available to your coder that are little to no cost for your facility to include CMS’ Local Coverage Determinations (LCDs), CMS electronic billing manuals, specialty society directives/websites, commercial carrier directives/websites, credentialing societies (i.e. AAPC AND AHIMA). This presentation will also include practices to avoid when researching valid coding directives.
Tuesday, December 11th – 3 Concurrent Sessions
Room 1:
HCPCS Reporting: Does It Really Work?
Presenter: Denis Rodriguez, CPC
8:00am-9:00am
Participants will learn reimbursement tips for commercial payers as well as discuss Medicare reporting practices when applicable to include facility best practices (i.e. implant logs, contract verbiage). Inappropriate off-label reporting of common HCPCS supplies/implants utilized in eye and integumentary procedures will be reviewed.
ASC Modifiers
Presenter: Denis Rodriguez, CPC
9:05am-10:05am
Learn the importance of modifiers to the reimbursement process. Emphasis will be placed on the most common modifiers utilized in an ASC as well as the appropriate sequencing of multiple modifiers. Participants will be gain a better understanding of "when" and "if" to apply modifiers GA, GY, GX, or GZ.
So You Think You Can Code? Hands on Operative Note Abstracting and Coding
Presenter: Denis Rodriguez, CPC
10:20am-12:00pm
Participants will be expected to code in this hands-on session. Actual operative reports reflecting common multi-specialty procedures will be provided to the participants. Utilizing their resources (participants will be asked to bring CPT Manuals), participants will review, abstract, and assign codes according to Medicare guidelines and edits. Operative reports will be reviewed. Best practices for abstracting from the operative report will be discussed as well as “what” to do when coding is denied by Medicare/MAC.
Understanding Pain Management from an Audit Perspective
Tamara Wagner, BS, CPC
1:00pm-2:00pm
With Ambulatory Surgery Centers seeing an increase in RAC reviews, now more than ever it is imperative your ASC facility is coding and billing correctly! This session will review the essentials of proper reporting of pain management injections from an ASC perspective. Appropriate coding guidelines for an ASC facility’s more common pain injection procedures will be discussed to include Local Coverage Determination utilization.
Knee Scope Tips and Traps: Maximizing Reimbursement
Tamara Wagner, BS, CPC
2:05pm-3:05pm
Learn proper coding guidelines to accurately report your ASC's Knee Arthroscopies. Coding directives from the AMA, AAOS, and Medicare will be provided as well as tips for coding arthroscopic procedures of the knee. Learn "when" a query is necessary so as to capture correct reimbursement for knee procedures. Understand correct application of the Medicare edits to avoid missed opportunities.
Colonoscopy Reporting: Medical Necessity, Surveillance vs. Screening, Avoiding Denials
Tamara Wagner, BS, CPC
3:20pm-4:30pm
Ensure your ASC is maximizing reimbursement by appropriately reporting colonoscopy procedures. Participants will gain an understanding between a screening versus a diagnostic colonoscopy and will learn when additional documentation is needed to determine code selection. Local Coverage Determinations, surveillance versus screening definitions, will be discussed as well.
Questions & Answers
4:30pm-5:00pm
Sessions will wrap up with a 30 minute questions and answer session. Participants will have this opportunity to discuss any additional coding challenges with the speakers regarding the topics covered throughout the day.
Tuesday, December 11th – 3 Concurrent Sessions
Room 2:
Sessions for Speaker Stephanie Ellis, R.N., CPC
Podiatry Reporting
8:00am-9:00am
If you have ever found yourself frustrated with trying to code Foot/Podiatry procedures, this session is for YOU! Learn about correct Modifier usage and how the Medicare CCI Edits work with these procedures to help you know when a procedure is and is not separately billable. Also included are the differences between the Bunionectomy procedures, which can be so confusing. Understand more about how to code and bill other frequently performed podiatry procedures (Hammertoe, Osteotomies, Tendon procedures and more).
Urology
9:05am-10:05am
Understanding the anatomy of the organs involved in these complicated procedures helps with correct coding. Learn about the intricate rules for Urology coding and the numerous CCI Unbundling Edits involving these procedures, which are now a serious Medicare RAC Audit focus issue. It is essential to understand when a Urology procedure is separately billable when it is Unbundled in the CCI Edits and when procedures can’t be separately billed (which happens more often than you would think). This session will help you avoid reimbursement and compliance issues with your Urology cases.
ENT/Ophthalmology
10:20am-12:00pm
While the coding of many ENT procedures can be pretty straightforward, there can be some circumstances where special coding knowledge is required to code properly and not leave money on the table while coding these procedures in a compliant manner. Payor guidelines can complicate billing for the relatively new Balloon Sinuplasty procedures and there are seven different procedures that can be billed for Turbinates – but how many procedures can be billed per side? While the coding of Cataract procedures is quite straightforward, there are a number of other Ophthalmology procedures performed in ASC facilities that are much more complicated and are easy to miscode. Learn what Medicare’s guidelines are for properly handling cases where Medicare patients are receiving a Premium IOL Lens in Cataract procedures. Understand more about the special guidelines you need to know for ENT and Ophthalmology procedures to code correctly and decrease coding and reimbursement problems for your facility.
Gynecology
1:00pm-2:00pm
This session will help you avoid reimbursement and compliance issues with your GYN surgery cases. Understanding the anatomy of the Genitourinary organs involved in these complicated procedures is essential to correctly coding these procedures. The CCI Unbundling Edits of these procedures can be confusing and obtaining a better understanding when these procedures can be billed will be covered in this session.
Pain Management: Injection Procedures and Neurostimulators
2:05pm-3:05pm
Medicare now has some Pain Management procedures as RAC Audit Focus Issues. Add to that the recent changes to the coding and decreasing reimbursement for pain management procedures, it is more important than ever to understand how to correctly code these frequently-performed procedures – to protect reimbursement and stay in compliance. As more and more neuro-stimulator procedures are being performed in ASC facilities, it is essential to master the coding of these complex procedures, which can involve a number of codes for each case and have very expensive implants. Payor guidelines can also be complicated when billing for stim. cases. Leave this session with a better understanding of these procedures.
Urology
3:20pm-4:30pm
Understanding the anatomy of the organs involved in these complicated procedures helps with correct coding. Learn about the intricate rules for Urology coding and the numerous CCI Unbundling Edits involving these procedures, which are now a serious Medicare RAC Audit focus issue. It is essential to understand when a Urology procedure is separately billable when it is Unbundled in the CCI Edits and when procedures can’t be separately billed (which happens more often than you would think). This session will help you avoid reimbursement and compliance issues with your Urology cases.
Questions & Answers
4:30pm-5:00pm
Sessions will wrap up with a 30 minute question and answer session. Participants will have this opportunity to discuss any additional coding challenges with the speakers regarding the topics covered throughout the day.
Tuesday, December 11th – 3 Concurrent Sessions
Room 3:
Sessions for Speaker Margie Vaught, CPC, CPC-H, CPC-I, CCS-P, PCE, MCS-P, ACS-EM, ACS-OR
ICD-10 in the Orthopaedic World
8:00am-9:00am
With October 2013 right around the corner and no confirmation from CMS that they have changed the deadline, it is not time to stop getting ready for ICD-10. Those providers treating musculoskeletal complaints will need to get a head start as the majority of ICD-10 codes will be located in this area of injury and fracture issues. During this session we will go over the guideline changes from ICD-9 to ICD-10, how to assign codes to the most common MS issues as well as understanding the different between the 7th character for fractures vs. injuries.
Hands and Wrist
9:05am-10:05am
Coding for hand/wrist surgical procedures can get confusing as well as complicated. This breakout session will cover procedures from basal joint arthroplasties to arthrodesis of the wrist as well as everything in between. Finger surgical procedures can also make you want to pull your hair out, with all the tendons and are they flexors or extensors and are you in zone II or not. These issues as well as many others will be discussed during the session.
Shoulders and Elbows
10:20am-12:00pm
To ensure accurate coding and proper payment this session will help you distinguish partial vs. complete synovectomy and limited vs. extensive debridement for the 29820-29823 series. Understand how to report the most specific code for typical shoulder conditions such as impingement, frozen shoulder, periarthritis and the various SLAP lesions. There will be discussion regarding acute vs. degenerative rotator cuff disease. The BIG issue of acromioplasty changes for 2012 will be discussed. Biceps tendon repair code, shoulder vs. elbow, and changes to ulnar neuroplasty at the elbow will be highlighted.
Spine Coding 101: Understanding Fusions, Decompressions, Laminectomies
1:00pm-2:00pm
During this breakout session we will dive into the most recent CPT guidance on the three new – and confusing – ways to code discectomy. Issues regarding corpectomy when done with arthrodesis and documentation regarding corpectomy. We will also discuss the confusion between codes 63042 vs. 63047. Changes in 2012 were made regarding the documentation and coding of instrumentation and grafting – are you doing them right? The new combo arthrodesis lumbar code will be discussed – what does it look like and what is bundled into it. Tips for your physicians on documenting the specific approach for discectomy procedures – percutaneous, endoscopic or open will be provided.
Spine Coding 201: Spinal Op Note Session
2:05pm-3:05pm
This is a stand-alone presentation. Spine 101 is not required. Participants will be expected to code in this hands-on session. Actual operative reports reflecting common spine procedures will be provided to the participants. Utilizing their resources (participants will be asked to bring CPT Manuals), participants will review, abstract, and assign codes according to Medicare guidelines and edits.
Hip and Knees
3:20pm-4:30pm
Open hip and knee surgical procedures can be difficult especially when it comes to revision of total joints. Many times these are 'staged' revisions and the coding will be different than unstaged revisions. This breakout session will take you through this process. Other knee surgeries such as patellar re-alignment procedures have bundling issues that will be discussed. SI joint injections also took a major change for 2012 are you documenting and coding correctly. These issues along with other open surgical procedures of the hip and knee will be covered.
Questions & Answers
4:30pm-5:00pm
Sessions will wrap up with a 30 minute questions and answer session. Participants will have this opportunity to discuss any additional coding challenges with the speakers regarding the topics covered throughout the day.
Cristina Bentin, CCS-P, CPC-H, CMA
Cristina Bentin is the president and founder of Coding Compliance Management, LLC, a healthcare consulting company specializing in the markets of ambulatory surgery centers with emphasis on business office assessments, coding support, reimbursement and training. Ms. Bentin is nationally recognized as a leading freestanding ASC coding educator, speaker, and writer with over 21 years of hands-on experience in ASC multi-specialty surgical coding as well as physician office coding. Ms. Bentin is a member of the American Academy of Professional Coders (AAPC) Certified Professional Coder Hospital based, a member of the American Health Information Management Association (AHIMA) Certified Coding Specialist – Physician based, an AHIMA-approved ICD-10-CM Trainer, a member of the National Association of Health Professionals and a member of the North American Spine Society. Ms. Bentin currently serves on the Education & Program Committee for The Ambulatory Surgery Center Association (ASCA).
Prior to establishing Coding Compliance Management, LLC, Ms. Bentin was CFO of a surgical hospital and participated in its start-up and development. She was also formerly the Director of Education for a medical consulting firm in which she was responsible for educational ASC coding seminars and audit processes. In addition, Ms. Bentin has had extensive experience as the education and training manager for a national healthcare corporation, and was directly involved in the continued education of its 200 + ASC facilities and coders nationwide ensuring OIG, Medicare and state requirements were met. She enjoys developing and providing educational seminars to meet the needs of ASC facilities. Ms. Bentin’s coding lectures include groups such as Federated Ambulatory Surgery Association, Ambulatory Surgery Center Association (ASCA), Ambulatory Surgery Foundation, Becker’s ASC, The Coding Institute, The American Health Information Management Association, The American Academy of Professional Coders, OR Excellence, and various individual state ASC Associations nationwide. She frequently contributes trade articles to Becker’s ASC Review and Outpatient Surgery Magazine.
Stephanie Ellis, RN, CPC
Stephanie Ellis founded Ellis Medical Consulting, Inc. (EMC) in 1992. EMC specializes in coding chart audits, business office operational assessments, litigation support, reimbursement research, difficult/challenging coding questions, outsourced coding, coding and billing training and compliance programs for ASC facilities, physician practices, hospitals, IDTF radiology facilities, and clinics nationwide. Ms. Ellis is an accomplished speaker and gives seminars nationally on such topics as ASC Coding and Billing Issues, Documentation Issues, Physician E&M Visit Coding and Documentation, Fraud and Abuse Issues, Nurse Practitioner/PA Billing, Medicare Denials, Specialty Coding, RAC Audits and Compliance Plans. Ms. Ellis is on the Advisory Board of OR Manager magazine and HCPro’s former publication Ambulatory Surgery Coding and Reimbursement Insider newsletter. She also serves on the Editorial Advisory Board of The Coding Institute’s Outpatient & ASC Coding Alert publication. She writes numerous articles on compliance, coding and billing issues for national magazines (Outpatient Surgery Magazine, Beckers ASC Review, ASCA Focus, AORN Magazine, OR Manager Magazine, AAPC, JustCoding.Com, etc.) on a regular basis. Prior to starting her company, Ms. Ellis worked as a Fraud Investigator at the Tennessee Medicaid Program. Ms. Ellis is an active member of the national Ambulatory Surgery Center Association and speaks at many of their meetings and at Beckers ASC national meetings. She is also a member of the AAPC, AHIMA, MGMA, HFMA and AORN. She has been a Board Member for 9 years and is and past Treasurer of FASCA of TN, the Tennessee state surgery center association.
Denis Rodriguez, CPC
Denis Rodriguez, CPC is a Senior Ambulatory Surgery Center Coder and Compliance Auditor for The Coding Network, LLC., the largest specialized coding company in the United States. He is certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC). Other certifications he has held include: Certified Ambulatory Surgery Center Coder (CASCC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Certified Coding Specialist (CCS), and a proficiency certificate in Emergency Department coding from the AAPC.
During his nearly 23 years of experience in the healthcare field, 10 years specifically coding for ASC's, Denis has managed a performance improvement and research department for one of the nation's largest owners and operators of ambulatory surgery centers. He managed a staff that educated and assessed approximately 60 ambulatory surgery center coders. In that capacity he directly wrote and oversaw the development of weekly and monthly coding newsletters and yearly coding refreshers. He has had articles published in specialty magazines such as Outpatient Surgery Magazine, Becker's ASC Review and AAPC's The Coding Edge. Denis has also served as a panelist for Coding Q&A: Ask the Experts, an online column of Advance for Health Information Professionals newsmagazine. He has performed hundreds of ASC coding audits for surgery centers throughout the country, identifying compliance issues and areas of missed revenue.
Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, PCE, MCS-P, ACS-EM, ACS-OR
Margie Vaught has over 25 years of experience in the healthcare arena, twenty of those years spent in the field of Orthopedics. She obtained Certified Professional Coder (CPC) designation in 1995 from the American Academy of Professional Coders (AAPC), where she served as a National Board Member for over 3 years. Ms. Vaught worked with AAPC as a technical support person in the Education Department, for over 3 years. In 1996 she obtained the status of Professional Credit Executive (PCE), which deals with extending credit issues, bankruptcy and collection efforts under the current legal system. She obtained the designation of CCS-P (Certified Coding Specialist – Physician) in September 2000 from American Health Information Management Association (AHIMA), and the credential of Medical Compliance Specialist-Physician (MCS-P) in Jan. 2001, providing a more detailed background of compliance issues as outlined by the OIG. In 2003, Ms. Vaught obtained the credential of ACS-OR Advanced Coding Specialist – Orthopedic. She is a recognized AAPC Approved PMCC Instructor. She has served as the technical advisor for the Orthopedic Practice Coder (PinkSheets), for DecisionHealth (DH) since 2000 and was Coding Content Specialist for DecisionHealth (DH) from April 2007 to March 2010, currently helping DH in Orthopedic relating products. Since 1998, Ms. Vaught has been providing consulting services to CodeCorrect.com/Medassets.com, in regards to their question and answer sections. In addition, she contributes and writes articles for the AAOS Bulletin on an ongoing basis as well as other publications such as AAPC Coding Edge, Orthopedic Technology Review and CodeCorrect. In addition, Ms. Vaught performs internal audits; education and training of physicians and office staff, and helps clinics and companies establish billing and coding compliance manuals, as an Independent Consultant. She also presents to physician offices/groups regarding documentation and coding requirements. Ms. Vaught is a current member of MGMA/ACMPE, BONES, AAPC, Society for Clinical Coding (SCC), PACHOM and AHIMA. She stays current by attending the annual conventions for BONES, AAPC, MGMA and also the AMAs CPT symposium.
Tamara Wagner, BS, CPC
As Vice President, Coding for National Medical Billing Services, Tamara Wagner leads an outstanding team of highly experienced and skilled ASC coders. She developed a training program for new coders and works to ensure that all NMBS coders stay current with trends and changes in the industry by engaging in continuing education training. Nationally renowned for her coding expertise, Ms. Wagner is a frequent speaker at ASC conferences and has written numerous articles in related trade publications. She has performed numerous coding audits for ASCs nationwide, identifying compliance issues and areas of missed revenue. Tamara holds a Bachelors of Science in Biology from St. Louis University.