AAPC March 21, 2007
Edge Blast Header

Issue #73

Top Stories
Test Yourself

Hold on to Your Original CMS-1500 (12-90) – At Least for Now

Due to formatting problems with the revised CMS-1500, the deadline for transitioning to its replacement has been extended beyond the original April 1, 2007 date. The Centers for Medicare & Medicaid Services (CMS) will notify contractors when to make the transition once the formatting issues are resolved. The National Uniform Claim Committee (NUCC) is responsible for the maintenance of the CMS-1500 form. CMS does not provide the form to providers for claim submission. The CMS-1500 form is the standard claim form used by a noninstitutional provider or supplier to bill Medicare carriers and durable medical equipment regional contractors (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid State Agencies. For more information, go to


Workshops - Get informed by attending an AAPC workshop in your area. Click here for a schedule and registration.

Visit our locate a workshop page for details.

AAPC Audio Conferences

A perfect way to stay informed of the industry without leaving home.

Visit our Audio Conference page for details or contact AAPC at 800-626-2633.

Chris Fraizer Top News

by Chris Fraizer, MA, CPC

Lack of Sleep Easier to Code than Catch Up

Most women don?t get enough sleep.
In fact, 60 percent of all American women are getting a good night?s sleep a few nights or less per week and, according to the same survey by the National Sleep Foundation (NSF), 43 percent of the women said that the subsequent sleepiness during the day affects virtually every aspect of the their time-pressed lives.

The lack of sleep affects women working out of home or at the home, and it may present a double whammy to the generation of women trying to juggle the place where they work ? home or office ? with the responsibilities of children and voluntary positions. ?I could be the poster child for the study,? said Betty Hovey-Johnson, CPC, CCS-P, CCP, CIC, and AAPC National Advisory Board member. ?I don?t even know what a full night of sleep is like anymore.?


Back to Top

Revised Appeals Process Could Reverse Loss of Medicare Privileges

The court docket was short but not all that sweet.
The physician lost his federal health program privileges based upon a Medicaid audit that found limited documentation of patient histories and physical examinations, a failure to document the patients' progress or response to treatment, an excessive ordering of medications without documented medical necessity, and billing for services not supported by documentation in the medical records.

The exclusion from Medicaid automatically suspended the physician from the Medicare program. There was no avenue for appeal beyond federal adjudicators. The combined exclusion extended over a two-year period.


Back to Top

Patients with Genetic Conditions Twice as Likely to Face Insurance Denial

Denial of health insurance coverage due to a genetic condition is a dread not without basis for families and individuals facing the possibility. “There’s a fear, no doubt about it,” said Joyce Dolcourt, Director of Public Policy for the Arc of Utah. “It’s the same for both dominant and recessive conditions. People are hesitant to participate in research that may help because they don’t want to be pegged as a carrier. That’s setting themselves up for insurance rejection.”

A study published in the American Journal of Medical Genetics goes against what Dolcourt and other advocates have spent long hours fighting in front of state and federal legislators: equal rights for people with disabilities across the board, including equal access to health care. Despite their efforts, and all the altruism of federal anti-discrimination legislation, individuals with genetic conditions are twice as likely to have health insurance denied. If not downright denied, the coverage is offered at rates most families find prohibitive.


Back to Top

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. Do 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.

1. A female who in her first trimester of pregnancy and who has a family history of idiopathic epilepsy talks to a genetic counselor about the risks of her newborn inheriting the disease. The patient does not show symptoms for the disease and she is not a known genetic carrier. The encounter lasts 45 minutes. What are the diagnosis and procedure codes?


2. Identify the following sleep disorders by their ICD-9-CM code:

Restless leg syndrome (Answer):

Insomnia with sleep apnea (Answer):

Obstructive sleep apnea (Answer):

Leg cramps related to sleep (Answer):

3. A patient is being seen to determine HIV status. The patient is not showing symptoms of the disease and is not part of a group considered high risk. Counseling is provided during the encounter for the test. According to ICD-9-CM guidelines, what are the diagnosis codes to report for the encounter?


4. If a congenital anomaly has been corrected, what type of code should be used in subsequent medical encounters to identify the history of the anomaly?


5. What are the protections HIPAA offers for people with disabilities?


Back to Top

Copyright ©2007 AAPC

Not displaying correctly?
Click here to view in your browser
Or visit: https://www.aapc.com/e-blast/issue73.html