AAPC January 22, 2007
Edge Blast Header

Issue #69

Top News

Medicare 2007 Revises Payments Despite Rollback of Conversion Factor

Self-Referral Law Extends to Nuclear Medicine Services

Grant Covers Reseach to Generate Further Data


Nominations for Networker of 2006
are now being accepted online, click here.

Nominations must be submitted by February 2, 2007

EdgeBlast Test Yourself


January 26, 2007
Austin, MN – Holiday Inn
Advanced E/M Coding
Stephen Levinson, MD

January 27, 2007
Saint Paul, MN – Lakeview Hospital
Surgical Orthopedic Coding
Annette Grady, CPC, CPC-H, CPC-P

February 3, 2007
Salt Lake City, UT – Primary Children’s Hospital
Advanced E/M Coding
Robin Linker, CPC, CPC-H, CPC-P, CCS-P, MCS-P, CHC

February 8, 2007
San Angelo, TX – West Texas Training Center
Advanced E/M Coding
Marla Wilson, CPC, CPC-H 

February 9, 2007
Loma Linda, CA – National University
Fundamentals of Interventional Radiology Coding
Sheldrian Leflore, CPC, BA 

February 9, 2007
Missoula, MT – St Patrick’s Hospital
2007 Coding Updates
Annette Grady, CPC, CPC-H, CPC-P, CCS-P 

February 9, 2007
San Diego, CA – Grossmont Healthcare
Pathology and Laboratory Coding
Vicky O’Neil, CPC, CCS-P

February 9, 2007
Wausau, WI – North Central Technical College
Fundamentals of Interventional Radiology Coding
Betty Hovey-Johnson, CPC, CCS-P, CCP, CIC 

February 10, 2007
Montgomery, AL – Holiday Inn
Advanced ICD-9-CM Vol. 1 and 2
Betty Hovey-Johnson, CPC, CCS-P, CCP, CIC 

February 10, 2007
Sacramento, CA – UCD Medical Center
Physician Coding for Inpatient and Critical Care
Vicky O’Neil, CPC, CCS-P

Visit our workshop page for more information.

AAPC Audio Conferences

January 24, 2007
How to Start a Chart Review
Annette Grady, CPC, CPC-H

January 30, 2007
Orthopaedic Coding
Margie Vaught, CPC, CPC-H, PCE, CCS-P, MCS-P

February 7, 2007
Sleep Medicine Coding: Staying Awake Through Updates
Jill Young, CPC

February 13, 2007
Diagnostic Dilemmas in Diabetic Coding
Vicky O’Neil, CPC, CCS-P

February 21, 2007
Functional Endocscopic Sinus Surgery
Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME

To register or for further information on upcoming audio conferences contact the AAPC at 800-626-2633.

Read the EdgeBlast and Earn CEUs Toward Your Annual Renewal

You can now earn continuing education units (CEUs) by reading the Academy’s EdgeBlast. Simply answer the five questions found in the EdgeBlast Test Yourself at the end of the Top Stories and submit your answers at the time of your renewal, using the same process you follow monthly for the Test Yourself in the Cutting Edge. Each EdgeBlast (there are two issued each month,) will feature five questions that can earn you .5 CEUs, for a total of 12 CEUs annually.

Chris Fraizer

Top News

by Chris Fraizer, MA, CPC
Medicare Auditors Recover Millions in Overpayments

Don’t think the rollback of the 2006 Medicare conversion factor will stagnate Medicare payments in 2007.

“This is not true,” warns Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, and president of CRN Healthcare Solutions in Tinton Falls, NJ. “There were many RVU changes from 2006 to 2007 and the fee schedule is a result of the new 2007 RVU values times the same conversion factor we had last year, in 2006. This spells changes for many codes.”

As most have heard, the down to the congressional wire Tax Relief and Health Care Act of 2006 set the 2007 conversion factor for physician payment at the same level as in 2006 ($37.8975), and reversed the anticipated 5.0 percent negative update that had physicians all but declaring their practices off limits to additional Medicare patients.


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Self-Referral Law Extends to Nuclear Medicine Services

The federal law prohibiting physician self-referral now cuts into diagnostic and therapeutic nuclear medicine services with amendments that took effect on January 1.

Unless an exception applies, the Stark Law prohibits physicians from referring Medicare and Medicaid patients for designated health services (DHS) to an entity with which they have a financial relationship. If an entity receives a prohibited referral, it may not bill Medicare for the resulting services.

The Centers for Medicare and Medicaid Services (CMS) added nuclear medicine services and supplies to the DHS categories of “radiology and certain other imaging services” and “radiation therapy services and supplies” in the Medicare Physician Fee Schedule for 2006 (published on November 21, 2005).

A one-year grace period was given so that providers could dissolve financial relationships that do not conform to Stark Law.

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Grant Covers Reseach to Generate Further Data

It used to be that getting a grant for health care research was close to a 50/50 proposition—the research team wrote the grant and the odds were favorable.

Not any more.

Despite some recent high profile philanthropic donations for health research, the increase in the number of researchers applying for grants, combined with the limited money available and projects open for study have pushed the odds closer to one out of 10.

So, what’s a research team to do?


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Project Xtern

Due to the high interest peaked by our January launch of  Project Xtern we are providing a follow up communication on that topic.

Project Xtern was developed by the AAPC as a mechanism to assist both our new and established medical professional coders/biller’s who want the professional edge that seasoned mentors can provide. Whether a student and brand new to the career of medical coding/billing or someone looking to transition to a new specialty, the Project Xtern assistance program provides the beginning coder with an opportunity to be voluntarily placed and gain valuable expertise at one of the AAPC Approved Official Extern Sites (AAPC AOES).

Being in a classroom is very different from applying that logic on the job.  The professional career of medical coding and billing requires education and mentorship.  Being shown how to apply previously learned logic and putting the classroom puzzle pieces together with the on the job experience is key for a well rounded education and an optimistic beginning in this career path.  Project Xtern provides that opportunity to our apprentice and student professionals.

An additional benefit is that once a person has completed an externship at an AAPC-AOES facility they will have the opportunity to showcase that experience on their resume when applying for future employment.

Our AAPC-AOES sites have been awarded this special designation because of their commitment to the medical coding profession, their understanding of the quality standard that is required of professional medical coders and their willingness to mentor a new professional coder.  These sites have the benefit of “trying on” the extern for 90 days or more without pay or benefits before extending an offer for employment if the need is present.  If that extern is offered employment after completion of the externship, the employer has an additional 90 days of probation before committing to the employee with benefits.  That is approximately six months of great reasons for these facilities to have agreed to participate in the AAPC’s Project Xtern program. 

Compliance is yet another reason for facilities to be involved with Project Xtern. Showing our state, federal and local insurance carriers that your facility is committed to the training and development of your team of professional medical coders and billers, for the reason of moral, ethical and legal coding and billing practices outlined by these carriers and that your professional mentorship program helps to secure that logic.

If you are a student member or a member looking for the Project Xtern experience of mentorship, be sure to check out our website at www.aapc.com for our up-dated list of  AAPC-AOES facilities. The only requirement to be placed at these facilities is that you are a current member in good standing. 

If you are a facility and would like to become an approved official extern site, you can find our AAPC-AOES application on our website at www.aapc.com .  Simply complete the application and fax it back to us to the fax number listed at the bottom of the application.

Project Xtern is a wonderful example of how the AAPC is working for the members by supporting the integrity of our credentials through education and mentorship.

Stanley M. Szelazek, CPC, CPC-H
Program Manager

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EdgeBlast Test Yourself

By answering the following questions you can earn .5 continuing education units to apply toward your annual Academy certification renewal. Simply answer the questions and send in a copy of your work when submitting your CEU package. Put the number of each EdgeBlast included in your submission. The number 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.

And don’t forget about the new CEU policy: CEU submissions will be submitted every two years instead of every year. The number required to submit for single certified members will be 36 every two years, 48 every two years for double certified members, and 60 every two years for triple certified members.

1. What are the five G codes that report the various levels of emergency visits, and found in the 2007 HCPCS Level II code set?

2. The Centers for Medicare and Medicaid Services initiated a screening benefit to detect abdominal aortic aneurysms this year and the benefit is offered as part of the Welcome to Medicare physical exam. What G code is used to report the screening benefit?

3. A trained genetic counselor provides 60 minutes of face-to-face services to a patient recently diagnosed with Long QT syndrome. What is the diagnosis code for the syndrome, and the CPT® code for the counseling?

4. The surgeon excises a melanoma of the trunk and prepares a 20 sq cm site for the immediate application of a skin graft (dermal autograft). What are the codes for the surgical preparation and the application of the graft?

5. The radiologist performs a bilateral diagnositc mammography using computer-aided detection in a procedure that includes further review and interpretation. What is the correct way to report the services provided?

1. Provide an example (code and descriptor) of a diagnostic or therapeutic nuclear medicine service that would be in violation of Stark Law if the service is provided by referral from a physician with an invested (financial) interest in the facility or device that would be used for the service. (hint: the web site for these codes is found in the related article)

2. How do you code a combination SPECT/CT study when the CT exam is performed for localization?

3. Code a two-day myocardial perfusion study, when both supine and prone gated SPECTs are performed.

4. The 2007 Physician Fee Schedule increases the work RVU for specific evaluation and management codes in relation to face-to-face time the physician spends with the patient. What is the intent of the face-to-face time?

5. What grouping of Category III codes describes heart CT imaging procedures?


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