Quality Coding on a Shoestring Budget

By Linda Farrington, CPC
Unless Congress takes action to stop it, physicians face a reduction in Medicare payments of about 10 percent in 2008. Total payment cuts of about 40 percent are predicted by 2016 — in just eight years. Sobering, indeed. We all know about the trickle-down effect — that when Medicare cuts its conversion factor and pares down its RVUs, so does the private sector. It means that you may soon have to thrive without much of the funding for resources that enables you to perform your job to the best of your ability.

Face budget cuts head on

As budgets decline in the workplace, often those things cut include coding resources (i.e. code books, medical dictionaries, medical encyclopedias, drug references, trade subscriptions, and continuing education for employees). Fortunately, we live in a world connected to the information highway. It’s on the Internet that you will find nearly all the information you need as a coder, and much of it is free.
The Internet is so full of information, it is often hard to disseminate. You have to know who you can trust, as there are plenty of unreliable sources on the Internet.

Online Publications

Coders’ Resource Handbook. Your membership to the AAPC grants you free access to several important resources. Simply go to the AAPC website and log in to the Members Area. Click on the Resources tab and the first item you will see listed is the Coders’ Resource Handbook. Download this publication to find, among other things, valuable links to important industry websites. Use this handbook as an online tool or print it out and use it as a reference guide.
Coding Edge. Also under the Resources tab is the Coding Edge magazine archive. Simply click on the issue you want to download. To find a specific topic in the PDF file, you can perform word searches by pressing [Ctrl]-F to highlight the Find field on the toolbar and entering a keyword. Each month, the publication also provides you with a way to earn one free CEU so that you can affordably maintain your certification.
EdgeBlast Under the Resources tab, you will also find past issues of the EdgeBlast newsletter that the AAPC distributes freely via email. You will need to log in with your member ID to specify how and what you want emailed to you semimonthly. Topics include recent legislative issues as well as coding-specific ones. Again, you can earn 0.5 free CEUs by completing the five test questions given at the bottom of each newsletter.
Code Books. The CPT®, ICD-9-CM, and HCPCS Level II books are costly but essential. The prices for these books on the AAPC website are very competitive, but it is always wise to shop around.
Tip: Did you know that you can also look up CPT® (although limited by the AMA), ICD-9-CM, and HCPCS Level II code sets on the web? Refer to the Coders’ Resource Handbook for more information.

Online Resources

Centers for Medicare and Medicaid Services. As CMS goes, so goes the industry. If you want to know more about CMS, specifically Medicare, simply go to the CMS website and click on the Medicare tab. If you search fearlessly, a wealth of information awaits you. Access the Medicare Physician Fee Schedule (PFS) to check RVUs for sequencing or to verify whether you can use a particular modifier with a specific code. When you open the PFS, you will be able to use this as a tool with many applications. Press [Ctrl]-F to search for a code. You will be able to view the complete fee schedule for a specific code including each RVU (work, practice expense, and malpractice), total RVUs, the professional and technical component indicators, the global days, the pre-, intra- and postoperative percentages, the indicators for modifiers for multiple procedures, bilateral surgery, assistant surgery, co-surgery, and team surgery, and much more. Refer to the Indicator List on page 9 of RVUPUF07 to determine what each indicator means for each modifier. It’s easier than it sounds, trust me.
The Correct Coding Initiative. Another very important tool when coding multiple procedure cases or perhaps more than one surgery on the same patient by the same surgeon on the same day is CCI. Scroll down, print and read the Modifier -59 Article. (Did you know that modifier 59 is not the only CCI modifier, but the modifier of last resort?) Click on the NCCI Policy Manual for Part B Medicare Carriers. Print the Intro, Chapter 1, and the Table of Contents (TOC) first and then print the selected chapters. Next, click on NCCI Edits – Physicians, save selected Service Type(s) to your computer, both Columns 1 and 2, and Mutually Exclusive.
Tip: If you are coding multiple procedure cases, it is imperative that you correctly bundle the codes. Routine unbundling can be determined as fraud. Checking CCI prior to sequencing will allow you to send out correctly coded, bundled, and sequenced claims the first time. If you use a bundling edit pre-claim, you will have a better chance of winning an appeal later and you won’t waste time (and money) filing appeals you can’t win.
CCI is not the only bundling edit out there. Due to over a decade of physician advocacy by organizations such as the AMA and recent settlements, insurers are beginning to make their payment rules available to contracted providers. They are also publishing medical payment policies on their sites.
Listservs. A Listserv is an electronic mailing list service that sends information right to your email address. Listservs are invaluable to coders due to the fact that our industry is in continual flux with constant updates and changes. As soon as a manual is purchased, it becomes obsolete. It is important that we think of ourselves as lifelong learners — something you have probably heard our National Advisory Board President, Deb Grider, say many times. When we invest in our education — even if the only cost is our time — we invest in ourselves and our future successes. It is just part of upholding a higher standard in our own lives.
On the MLN website, you will find an item on the left column called Join a Listserv. Sign up with this service to be automatically notified via email as soon as new educational products become available. Additionally, many other CMS mailing lists are available.
Medical Dictionaries. There are some great medical dictionaries on the web, including The Free Dictionary, MedlinePlus’ Medical Dictionary, MedTerms’ Medical Dictionary, and Medical Dictionary.
Medical Encyclopedias. There are also numerous medical encyclopedias available on the web. Here is a list of some that I reference: AMA Atlas of the Body, Instant Anatomy, National Institutes of Health National Library of Medicine, MedicineNet.com, and mediLexicon (which includes medical abbreviations, a medical dictionary, a drug search, an ICD-9-CM search, and more).
Drug References. Drugs.com and MedicineNet.com are good places to go when you need to know why a patient is being prescribed a certain drug. You can also “Google” a drug. You will likely get the link to the manufacturer and very reliable information.


Medicare Learning Network. Another great resource available on the Internet is the MLN. The AAPC recognizes its web-based training courses and awards CEUs for successful completion. You can print certificates directly from the CMS website.
Workshops. In 2008, the AAPC is rolling out a handful of new workshops especially designed to make continuing education more convenient and affordable. Go to the AAPC website at www.appc.com for details.

Online Networking

Member Forums. Networking is essential and the AAPC provides you a convenient place to do it in the Member Forums. Look for it on the AAPC website under the Coder Community tab. Among other things, you will find discussion groups by specialty. It’s a great place to get answers to some of your tough coding questions.

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