The Edge Blast E-Newsletter
posted 06/20/2007
Electronic news for June 2007
Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal
Earn continuing education units (CEUs) by reading the EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the AAPC Cutting Edge. Each EdgeBlast (there are two issued each month) will feature five questions that are worth .5 CEUs, for a total of 12 CEUs annually.

Are You Adequately Immunized?

By Constance Valdez, CPC, CCP, RMC

Vaccines are not just for kids — adults also need to stay current with immunizations to maintain good health. If we take away the protection of vaccination, we could open the door to more people becoming infected and spreading diseases to others, thus undoing all the progress we have made over the years. In other words, we vaccinate to protect the future.

The Centers for Disease Control and Prevention (CDC) reports that all adults should get shots for tetanus and diphtheria (Td) every ten years. The CDC changes this recommendation to every five years when an injury such as a laceration occurs. For this service, you’ll report 90714 for the preservative-free vaccine, and 90718 for the standard Td vaccine. In addition, don't forget your administration code(s) from the 90471-90472 range.

Before age 65, a vaccination for tetanus, diphtheria and pertussis should take the place of one Td booster (Tdap) (for which you’ll report 90715). All adults born after 1956 should be immunized at least once against measles, mumps and rubella (MMR), and this corresponds to codes 90707-90708.

People age 65 or older, as well as younger adults with diabetes or chronic heart, lung, liver or kidney disorders, should get at least one pneumonia shot (code 90732).

The CDC also recommends that adults older than 50, pregnant women, health care workers and residents of long-term care facilities get influenza shots every fall, (reported with codes 90656, 90658 or 90660). Adults in high-risk groups, such as health care workers, people with multiple sex partners and international travelers, should get a hepatitis shot (code 90746).

To learn more about vaccinations and to get colorized vaccination schedules, go to the CDC's National Immunization Program (NIP) website:

Constance Valdez, CPC, CCP, RMC, is the coding and compliance specialist at Concentra Health Services in Dallas, TX.

Reduce Certification Exam Anxiety

By Cindy Harms, M.Ed., CPC, CPC-H

How do you get ready academically and psychologically for the certification exam?

Decide which test is for you. If you want to be a facility/outpatient hospital coder, then the CPC-H is your test. Is your goal to be a physician or mid-level provider-based coder? Then the CPC certification exam is best. Would you prefer to work within the payer environment? Then prepare for the CPC-P exam.

Streamline your testing skills. Make sure you give yourself enough time to complete the test. Remember a blank answer is the same as a wrong answer. Answer all the questions you can quickly and go back to those that you struggle with. Try not to spend too much time on any one question.

Understand how to approach and analyze the type of questions on the test. These exams are mostly multiple choice with a few true/false questions. With the multiple choice question, you will need to apply your knowledge to scenarios you have not read before. Straight memorization of facts may not be enough. You cannot just be familiar with the material — you must be able to analyze it.

Memory experts say that distributive learning, or studying that is spread over a long period of time, is better than cramming right before the test. Regularly organize your notes. Work on "thinking like a coder." Keeping up with reading assignments will reduce pressure as the exam date gets closer.

These tests are designed to test your ability to use the CPT®, ICD-9 and HCPCS manuals to find codes. Strive to be proficient when using them.

Break up the course material into small chunks. Ask questions. Join study groups.

Use in-test strategies when taking the certification exam. Preview the whole 150-question exam so you know what to expect.

Recycle through the test. First, answer the questions you can answer quickly because you know the answer. Go through the test a second time and answer questions that need a little more thought. Then, go back and answer the questions that you left blank. Answer all of the questions, even if you have to guess.

Pace yourself. Each exam is five hours long, which averages to two minutes per question. You will get progressively more tired as the hours go by. Perhaps you'll want to answer several questions from the beginning, middle, and end of the test at the same time so that you won't be answering all the questions from the last section when you are most tired.

Read each question carefully. Circle or underline keywords. When given a choice of four possible answers, you are looking for the best answer, not the answer that would be correct in every situation. Remembering that all CPT® codes within a section start with the same number (i.e., Radiology codes start with 7) and understanding modifier usage will help you eliminate wrong answers.

Get a good night's sleep before exam day.

Relax, do your best, and remember, you can take it again if you don't pass it the first time.

Cindy Harms, M.Ed., CPC, CPC-H, has 30 years of experience in the medical field including 12 years experience teaching CPT® and ICD-9-CM coding and reimbursement methods. She is an approved Professional Medical Coding Curriculum instructor.

How High Risk Medication Management Can Affect Medical Decision-Making

By Pam Brooks, CPC

One factor that affects the level of medical decision-making (MDM) within an E/M visit is the management of "high risk" medications. This phrase is misleading because according to current auditing guidelines, the criteria that must be met is the documentation of "drug therapy requiring intensive monitoring for toxicity." In actuality, this management option isn't only about the type of drug, but could refer to the frequency and vigilance of monitoring that is required to ensure therapeutic levels, avoid drug interaction and ultimately support patient safety. The key word here is "intensive."

Many prescription drugs could be considered "high risk," including insulin, Synthroid®, Coumadin®, Dilantin® and Digoxin®. From an auditing perspective, the purpose of this management option is to not identify a patient as a high-risk only because of the medications that they are currently taking, but because of the frequency and amount of monitoring that is taking place while they are on these meds.

Although subcutaneous insulin is considered a high-risk medication per most hospitals’ policies, unless the physician ordered weekly or bi-weekly serum blood tests to monitor the efficacy of the insulin, this may not meet the definition of high-risk management. A newly diagnosed Type I diabetic child might meet this level of management, but a long-term, well-managed diabetic may not. Coumadin® is usually considered an extremely high-risk medication, but if the patient has been receiving anti-coagulation therapy for an extended period of time and requires only periodic PT-INR checks based on a well-controlled regimen, then this alone might not be considered high-risk monitoring.

Clearly, it is up to the provider to document both ongoing laboratory monitoring as well as any concerns, findings or recommendations that pertain to the patient's medication management, particularly as they relate to current or possible toxicity, adverse affects or counter-indications. The documentation must be thorough, not only illustrating how long the patient has been handling this condition, but also outlining co-morbidities, compliance with treatment, changes in treatments, lifestyle, recent illnesses, stress, etc.

This kind of documentation will assist the coder in determining if it would be appropriate to consider a high-risk management situation.

This alone, however, will not drive your code. For a new patient, the history and examination must be at a comprehensive level. The MDM must also indicate the specific tests being ordered, as well as the frequency and why. With all of these factors at the appropriate level and the documentation proving medical necessity, the service can be billed appropriately at the 99204, 99205, 99222, 99223, 99254, 99255, 99244, or 99245 levels (consultation must meet additional requirements).

Pam Brooks, CPC, is the physician services coding supervisor at Wentworth-Douglass Hospital in Dover, NH.

CMS Offers Open Door Forum on Medicare Enrollment

CMS announced today that it will hold a special open door forum (ODF) on June 29 at 2:00 pm Eastern time to discuss tips that can help facilitate Medicare enrollment.

As part of the ODF, CMS officials will share information about the 2006 Medicare enrollment applications, and will provide useful tips on how providers can enroll in the Medicare program. Following the CMS discussion, Medicare staff will take comments about the Medicare enrollment process.

Anyone interested in participating in the ODF should register by June 27 at 2:00 pm (eastern time) at

CMS Revises PQRI Specs

Earlier today, CMS announced revisions to the final 2007 PQRI Measure Specifications. This version (1.1) will incorporate technical corrections that were made to the previous versions. Coding professionals interested in reading the revisions should visit the “measures/codes” section of CMS’ PQRI website at

New Study Reveals the "Real" Cost of Offshoring

Coding professionals are well aware of the recent trend of outsourcing business offshore so employers can potentially save money. But a recent Business Week article suggests that "shifting production overseas has inflicted worse damage on the U.S. economy than the numbers show." Although analysts initially believed that offshoring was not negatively impacting the economy, the new statistics show that a problem does indeed exist. To read the full text of the article, visit the link below.

Looking for Kudos

Have you recently filed appeals that brought in an extra $1 million in revenue for your facility? Have you spoken at your state medical society? Did you run the Marine Corps Marathon? We'd love to hear about it! Please submit your Kudos to our editors at

EdgeBlast Test Yourself

Answer the following questions and you can earn .5 continuing education units to apply toward your annual AAPC certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package or enter your CEUs into the CEU Tracker online. Include the issue number (example: #79) off each EdgeBlast on your submission, which is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources, such as your ICD-9-CM, CPT® and HCPCS manuals.

1. Code 90732 corresponds to what type of immunization?


2. Is Coumadin® usually considered a high-risk medication?


3. How many questions are on the AAPC’s certification exams?


4. The CDC recommends that adults older than 50, pregnant women, health care workers and residents of long-term care facilities get what type of immunization every autumn?


5. What should a coder do if they are struggling to answer a particular question on the certification exam?


CPT® codes copyright 2007 American Medical Association. All Rights Reserved.
CPT® is a trademark of the AMA.
No fee schedules, basic units, relative values or related listings are included in CPT®.
The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use.