AAPCs Las Vegas National Coding Conference April 5-8, 2009

Venue: The Rio Suites

Location: Las Vegas, Nevada, United States

Event Date/Time: Apr 05, 2009 End Date/Time: Apr 08, 2009
Registration Date: Mar 15, 2009
Early Registration Date: Jan 15, 2009
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Monday, April 06, 2009 GeneralBack to top8:00 AM - 9:00 AM Reed Pew's Conference Address

9:00 AM - 10:00 AM Keynote Presentation

Breakout Session 1Back to top10:15 AM - 11:45 AM 1A – The Comprehensive Error Rate Testing (CERT) Program and Recovery Audit Contractors (RACs)

Mary Vier , BA, CPC
Governmental audits are enough to make your head spin like a roulette wheel. As coders, you play a vital role in assuring your facility/practitioner remains compliant based on the information you are provided. Audits are not a game of chance; learn how to improve your odds and the outcome.

10:15 AM - 11:45 AM 1B – Hormones - Mystique? Mistake?

Glade B Curtis, CPC, COBGC, JD, CPC, CHCC
Hormone replacement therapy (HRT) and coding is confusing and frustrating. In 2002 the Women’s Health Initiative (WHI) study of HRT was stopped early because of concern for increased risks of breast cancer and stroke. Doctors and aging patients struggle to find solutions and alternatives. Mainstream and big name pharmacies are advertising “compounded products,” natural, or bio-identical hormone solutions. And for male menopause – finally, “andropause.” Medical science and coding issues will be explored.natural or bio-identical hormone solutions. And for male menopause – finally, “andropause.” Medical science and coding issues will be explored.

10:15 AM - 11:45 AM 1C – How to Build your Coding Career

Susan Goldsmith, CPC, CPC-H, CPC-P, CPC-I
Discover how being a CPC, CPC-H or CPC-P can benefit your career. Explore how coders can participate in every aspect of health care. Consider alternative career paths you never knew existed and learn how to advance your career while making a difference.

10:15 AM - 11:45 AM 1D – Pediatric Guru: Coding & Billing in Pediatric Practices

Lisa Jensen, MHBL, CPC, FACMPE
Explore the important day-to-day coding challenges of pediatric practices. You will learn how to maximize reimbursement through E/M coding, common procedure codes, and modifiers. We will also discuss how to get paid for your coding, how to handle rejections of codes, and where to turn when you cannot appeal anymore.

10:15 AM - 11:45 AM 1E – Coding Ethics – Navigating, Avoiding, and Surviving Real-World Problems

Brad Hart, MBA, MS, CMPE, CPC
Medical coders are not immune to the issue of ethics. There are elements of coding that make ethical issues a more prominent consideration. Coders must be ready to face ethical issues as they arise. Specific tips to help coders develop strategies for addressing ethical issues will be provided.

10:15 AM - 11:45 AM 1F – The Neoplasm Table – Six Columns of Confusion

This table has a unique role in coding, identifying abnormal cells both in their location and in the cell’s actions, and potential harm to the body. Each of the six columns in the table has a distinct role in coding. One must understand the role of the table, when to use it (and when NOT to), which column to use, and when anatomical markers are significant. Most coders use the table infrequently so when they turn to it, it is important that they have a good understanding of the table and a firm grasp of the ramifications of their code selection.

Breakout Session 2Back to top1:30 PM - 3:00 PM 2A - Coding Productivity Standards – Best Practices

Sheryll Hardesty, CPC, CCS; Lorraine Clement, CCS
This program will look at coding standards in different settings, based upon the scope of work. There will be an overview of studies that have been done on coding productivity standards, and participants will gain practical knowledge of how to set up coding productivity measurements based on the Vetrans Health Administration experience.

1:30 PM - 3:00 PM 2B - Advanced Principles in Physical Medicine Coding

Focus on common errors in physical medicine coding associated with improper service classification, and provide an in-depth review of AMA and CMS time-based service coding rules applicable to physical medicine services, as well as documentation tips to avoid post payment liability.

1:30 PM - 3:00 PM 2C - Compliance Primer: Understanding the Fraud and Abuse Enforcement Environment

Julie Chicoine, Esq, RN, CPC
This presentation will provide the coding professional with an overview of basic principles regarding the current health care fraud enforcement environment, including an overview of federal fraud and abuse laws, Office of Inspector General compliance program requirements, as well as OIG enforcement provisions, such as corporate integrity agreements and similar settlement agreements.

1:30 PM - 3:00 PM 2D - Advanced ICD-9-CM

Sheri Bernard, CPC, CPC-H, CPC-P
Diagnostic coding may be some of the most complex coding you perform, and it is becoming increasingly difficult as diagnostics play a growing role in reimbursement. Learn from the experts what you need to know about sequencing, causal relationships, and tertiary diagnoses, as we dig into Coding Clinic and the Official Coding Guidelines for the answers to our ICD-9-CM questions.

1:30 PM - 3:00 PM 2E - Electronic Health Records: Emerging Opportunities for Coding Professionals

Michael Stearns, MD, CPC
This presentation will provide an overview of electronic health records (EHRs) from a coding perspective. It will also discuss how coding professionals can take advantage of their knowledge and skills to play a key role in pay-for-performance programs and other initiatives related to EHRs.

1:30 PM - 3:00 PM 2F - Designing Superbills – Get Them Right the First Time

M. Jeanne Yoder, CPC, CPC-I, RHIA, CCS
Superbills are more than a numeric list of codes. Learn when to use, how to use, the correct way to format, get practice buy-in, and teach doctors how to use superbills. Improve the efficiency of your coders while making coding more interesting. Learn why superbills are only updated in late September and December.

1:30 PM - 4:45 PM Anatomy Expo - Monday (Concurrent with Session 2 and 3)

New This Year: This is a three-hour expo that will focus on different parts of anatomy. Experts will lead the classes, which will feature anatomic models, coding scenarios, and question and answer periods. Topics include obstetrics, dermatology, gastroenterology, and urology. It is repeated three (3) times during conference. Please note that it overlaps with subsequent breakout sessions.

Breakout Session 3Back to top3:15 PM - 4:45 PM 3A - Consolidated Billing: Who? What? When? and Why? Strategies for Understanding the Cards Dealt

Angela Poole-Taggart, CPC
Consolidated billing has a long-standing history of confusion. As a professional, you are tasked with determining what services are coded based on patient status and the place of service. This session “deals” each card of consolidated billing for Medicare patients and teaches tips and tricks for managing the cards dealt.

3:15 PM - 4:45 PM 3B - Anesthesia

Mark Leib, MD
Common anesthesia and pain procedure claiming errors will be presented for discussion. Explore how to select the correct anesthesia code(s) corresponding to those procedures. We will also discuss the new 2009 anesthesia codes and provide examples of surgical procedures included under those codes.

3:15 PM - 4:45 PM 3C - ICD-10-CM, The Time to Begin Preparation is NOW

Deborah Grider, CPC, CPC-H, CPC-P, CPC-I, CPC-E/M
ICD-10-CM is the diagnostic coding system that is expected to replace ICD-9-CM sooner than you think. In a world in which documentation remains a coder’s number one problem with physicians, how can we seamlessly move from a system with 17,500 codes to a system with 155,000 codes? We’ll give you some ideas. We will discuss preparation of implementation and analysis of ICD-10-CM for physician practices, hospital departments and payers small or large. This session will provide a basic understanding of the new classification’s conventions, guidelines, and specifications, develop your familiarity with new terminology, accelerate the learning curve, demonstrate your understanding and preparedness with this important new classification, understand the latest regulatory issues involved with the conversion to ICD-10-CM, and provide guidance as to steps you can take to “get ready.”

3:15 PM - 4:45 PM 3D - Modifiers

Katherine Abel, CPC, CPC-I
Rolling the dice on which modifier to use is always too big a gamble for any practice. Come learn how to keep from using the game of chance on modifiers. We will explore the use of modifiers in detail. Examples of appropriate and inappropriate uses for modifiers will be reviewed. Let’s stop rolling the dice together!

3:15 PM - 4:45 PM 3E - Coding Procedures for Cardiac Workup

Sharon Oliver, CPC, CPC-I; Steven Smith, MD
We’ll take a trip through the Chest Pain Center and introduce you to the procedures for a basic cardiac evaluation of a patient presenting with a complaint of chest pain. You will see an actual case of a transthoracic echocardiography with Doppler studies, followed by nuclear medicine slides that will lead to the cath lab for a left heart catheterization. Also, you will see balloon angioplasty and stent placements in the occluded coronary arteries. This will be a dual presentation correlating the CPT® codes as the procedure is being shown.

3:15 PM - 4:45 PM 3F - CPR for your CDM

Jan Norris, CPC, CPC-H
Think there is nothing more you can do to make your chargemaster come alive? This session will explore some different processes and ideas for maintaining compliance and discovering revenue opportunities in your CDM.

Tuesday, April 07, 2009 GeneralBack to top9:00 AM - 10:00 AM Awards

10:00 AM - 11:00 AM General Session - Everything You Need to Know You Can Learn from Other Coders

Designed specifically to teach practical “survival” skills that coders can use right away, both in their personal and their professional lives. This upbeat motivational session utilizes humor, creativity, and metaphor with combined practical and common sense solutions that no coder should miss.

Breakout Session 4Back to top11:15 AM - 12:45 PM 4A - Documentation and Coding Faux Pas and How to Avoid Them

; Bruce Rappoport, MD, CPC, CIMC, CPC, CCS
In a perfect world, documentation and coding would always be a perfect match. But from time to time errors arise in matching appropriate CPT® codes to provider documentation. This presentation will focus on some of these errors that can cause coding difficulties, and working with your provider to prevent them.

11:15 AM - 12:45 PM 4B - Stereotactic Radiosurgery

Suzanne Quinton, CPC, CPC-ORTHO
This course provides the coder with the basic concepts of stereotactic radiosurgery and an introduction to treatment and planning. Some basic anatomy will be discussed as relevant to the different types of tumors treated with radiosurgery, i.e., intracranial, spine, lung, and soft tissues. Coding instruction will be reviewed for all specialists involved. Case studies will be given, along with actual film footage of the planning and treatment.

11:15 AM - 12:45 PM 4C - Auditing Issues in ER

Raemarie Jimenez, CPC
In this session, we will review emergency department cases studies. Each case will be coded and discussed. We will review common problematic coding scenarios in this specialty. Bring your coding books; this is aninteractive session.

11:15 AM - 12:45 PM 4D - Medicare Risk Adjustment – ICD-9-CM Coding and Documentation Training

Carol Olson, CPC, CPC-H, CPC-I, CPC-E/M, CCS, CCS-P
The challenges facing coding and billing in the physician office setting are numerous. The role of documentation has changed dramatically, bringing diagnosis coding to a new level of importance. The quality of diagnosis coding must improve in order to receive the appropriate and accurate reimbursement from CMS. A thorough knowledge of ICD-9-CM coding guidelines is essential to accurate coding and billing. This session will walk through the Medicare Risk Adjustment payment methodology, the importance of documenting chronic conditions in the medical record, official coding guidelines and concepts, frequent coding errors and specificity in coding. The process of collecting and reporting diagnosis data is complex, and careful documentation is critical to accurate and complete data collection for risk adjustment. The medical record must describe the encounter and the reason for the visit such as the condition, symptom, or diagnosis requiring attention. We will discuss the requirements for data validation for CMS Risk Adjustment.

11:15 AM - 12:45 PM 4E - Communication or Bust

Rhonda Buckholtz, CPC, CPC-I
Communication can make or break a practice, no matter how good the care. Learning what communication is effective and where to apply it is a must for any successful practice. During this class we will discuss communication from every aspect of a practice and follow the flow to the very end leading up to reimbursements and appeals. We will cover front office as your first defense, ancillary staff and how they fit in, physician buy-in, LCDs and NCDs, coding vs. billing, communicating through contracts, and appeals and your bottom line. This is one course when what happens in Vegas shouldn’t stay in Vegas!

11:15 AM - 12:45 PM 4F - Critical Care from a Physician’s Perspective

David Young, DO
What is really happening during the performance of a critical care visit? This physician’s perspective on the performance of critical care will help the coder understand the most frequent disorders seen in a medical ICU including ARDS, causes of respiratory failure, sepsis, and the various causes of shock. The presenter will review the elements of billing for critical care time in detail, including explaining the elements that are not permitted in the time element of the code.

Breakout Session 5Back to top2:15 PM - 3:45 PM 5A - Decoding the MPFS Database

Lindy Lady, CPC
Using the Internet to access and demo the database, this session unfolds the mystery of the MPFS and walks you through accessing, locating, and reading the information in the columns. Learn to put this tool under the magnifying glass and make it work for you and your office!

2:15 PM - 3:45 PM 5B - MOHS Surgery Coding: Changes and Revisions

Scott Dinehart, MD
The CPT® codes for Mohs surgery are unique in that they require the physician to act as a surgeon and pathologist. These codes have undergone a recent revision. In this session, the Mohs codes will be explained and correlated with photographs of the actual surgical and pathology processes.

2:15 PM - 3:45 PM 5C - Claims Editing: More Than Just Denials?

John Neuman, III, CPC
New technology has made claims editing and analytics faster and more accurate. How does this impact you? Can it be a good thing? This session dispels common myths about clinical editing, explains how CMS and many payers now analyze your claims data, and how this actually benefits you.

2:15 PM - 3:45 PM 5D - It Starts with a Pap

Kerin Draak, WHNP-BC, CPC, CPC-E/M
This session will cover basic anatomy of the cervix, what a Pap test is, and how it is coded. Actual pathology slides will be presented to give the audience a better understanding of abnormal pathology. An educational video demonstrating a colposcopy with biopsies will also be shown. We will review the current practice guidelines for the management of abnormal Paps, and the appropriate CPT® and ICD-9-CM codes that correspond. We will discuss the HPV and the role it plays in cervical cancer, new HPV vaccinations, and the many new diagnosis codes that were added for 2009 for abnormal Paps.

2:15 PM - 3:45 PM 5E - The Medical Necessity of Plastic Surgery: Need vs. Choice

Terri Thomas, CPC, CPC-H, CPC-I
We will highlight the differences between cosmetic surgery and reconstructive surgery, and which procedures are covered by insurance. Insight will be provided into coding different types of procedures and the documentation requirements needed to provide medical necessity. ICD-9-CM, CPT®, and modifiers will be reviewed for accurate coding and the appeal process.

2:15 PM - 3:45 PM 5F - Increase Your Charge Capture for Ambulatory Infusion Centers

Jennifer Hildebrandt, MBA, CPC
Over the course of eight months, the Ohio Region of Kaiser Permanente increased charge capture in its ambulatory infusion centers by $1 million per month. Learn about the cross-functional strategies they employed to turn around this portion of their business.

2:15 PM - 5:30 PM Anatomy Expo (Concurrent with Session 5 and 6)

New This Year: This is a three-hour expo that will focus on different parts of anatomy. Experts will lead the classes, which will feature anatomic models, coding scenarios, and question and answer periods. Topics include obstetrics, dermatology, gastroenterology, and urology. It is repeated three (3) times during conference. Please note that it overlaps with subsequent breakout sessions.

Breakout Session 6Back to top4:00 PM - 5:30 PM 6A - Cytopathology and Surgical Pathology – "Make a Mountain Out of a Mole Hill"

Kathy Dirksen, CPC; Sophie Ghafari,SCT (ASCP), MBA, CPC
Without a doubt, the least descriptive and informative codes in CPT® are found in the laboratory and pathology section. Abstracting information from complex and difficult surgical and cytopathology reports, we will demonstrate techniques to maximize reimbursement benefits by appropriate code selection and precise medical report language. Our picture-rich presentation will visit cases from surgery to gross dissection, slide preparation, final diagnoses, reporting and coding. We will cover cytopathology coding from fine-needle aspiration to Pap test evaluation. This session will illustrate anatomy from head to toe and organs in between. You will learn what a unit of service is in pathology and how to avoid up-coding. Attendees will be able to start fresh in their knowledge of pathology coding.

4:00 PM - 5:30 PM 6B - Liver Transplantation—A Coder’s Trip to the OR

Shelly Bauguss, CPC, CPC-ANEST, CPC-GENSG; Majella Doyle, MD
Take a surgeon’s guided tour of a liver transplant as he or she performs the hepatectomy, backbench and reconstructive procedures, and the transplant itself by viewing a slide presentation, which will include video. We will also discuss the different types of liver transplants. Then we will walk through the corresponding documentation. CPT® and ICD-9-CM coding principles will be discussed.

4:00 PM - 5:30 PM 6C - High Stakes and Sure Bets for the ASC Coder

Donna SanGiovanni, CPC
Coders face unique challenges and ever-changing policies in an ambulatory surgery center setting. Join us to explore ASC coding including CPT and ICD-9 review, proper use of modifiers, hands-on operative note coding, contract negotiation skills and management tips.

4:00 PM - 5:30 PM 6D - Returning Heroes and Their Catastrophic Injuries

Rebecca England, MD, CPC
This program will focus on the catastrophic injuries of our nation’s returning heroes. Learn how new procedures, prosthetics, diagnostic efforts, and code development are required to adequately treat and describe the severity and extent of the physical and mental ramifications of the war.

4:00 PM - 5:30 PM 6E - Reconstruction of the Mandible, Including Microvascular Techniques

Janice Gollihur-Davidson, CPC, MD, CPC-H, CIRCC, CPC-CARDIO
This will be a discussion of the reconstruction options and techniques for mandible repair due to cancer, trauma, or disease. A comprehensive discourse on the diagnosis and treatment of mandibular reconstruction using fixation, grafts, and vascular anastomosis will also be presented.

4:00 PM - 5:30 PM 6F - The Range of Motion for Physical and Occupational Therapy

Lynn Anderanin, CPC, CPC-I; Mary Jo McManamon, CPC
Whether you are new to PT/OT, or just verifying you are coding correctly, this session will review the current movements, to include current coding trends, DME, incident to, and Medicare therapy caps, if applicable.

Wednesday, April 08, 2009 Breakout Session 7Back to top11:00 AM - 12:30 PM 7A - ABNs

Donna Morton, CPC
Advanced Beneficiary Notices (ABNs) protect not only the patient, but physician offices as well. Learn when they are needed, how to administer one, and what is required. Coding implications focus on application of the correct modifiers and documentation to assure proper reimbursement and protection from “folding” on a winning hand.

11:00 AM - 12:30 PM 7B - MS-DRGs—How to Capture the Most Effective Data for Coding MS-DRGs

Sandra Soerries, CPC, CPC-H
Attendees will develop an understanding of coding for MS-DRGs used for inpatient projective payment and Medicare. This session will cover the details of how cormobities affect the coding of MS-DRGs. Documentation guidelines with instructions on physician querying is an important part of MS-DRGs as we continue this transition. Ideas for physician education and the financial impact of the MS-DRG will be discussed.

11:00 AM - 12:30 PM 7C - How to Effectively Teach E/M to Your Doctor in One Hour

Stephanie Jones, CPC, CPC-E/M
Learn how to quickly and easily teach physicians to document and select levels for patient visits. Get real tips for everyday problems physicians have with code leveling a patient service, learn how to decrease documentation time, identify when the “extra bullet” is really warranted, and recognize a level of service immediately. We will discuss how to get buy-in to reduce under-coding, and keep a physician out of harm’s way during an audit. Learn how to communicate the principals of accurate code selection and documentation requirement using a process that delivers the information in less than an hour and is easy and logical for physicians to grasp and immediately implement. This seminar provides you with specific techniques that translate to improved documentation, accurate code selection, and bottom line results.

11:00 AM - 12:30 PM 7D - Common and Complex Endovascular Interventional Procedures

David Zielske, CPC-H, CIRCC, CCC, CPC;
This session will review the nuances of percutaneous angioplasty, atherectomy, stent placement, endovascular stent-graft insertion, dialysis graft/shunt intervention, thrombolysis and thrombectomy. An explanation of the procedure and pertinent anatomy, followed by common coding and documentation pitfalls will be discussed, as well as case examples describing both common and complex scenarios.

11:00 AM - 12:30 PM 7E - Fraud, Abuse, Provider Coding Error? Using Clinical Analytics to Know for Sure

Dennis Milhale, MD
Learn how organizations are successfully incorporating technology and clinical analytics to manage overpayments and identify fraud and abuse. Topics to be discussed include: using technology to identify and reduce provider overpayments due to inappropriate evaluation and management (E/M) coding, and doing so without alienating the provider network; implementing a comprehensive pharmacy fraud, waste, and abuse program; distinguishing fraud and abuse from coding errors and educating providers proactively to avoid more serious problems; building defensible claims management strategies based on well-defined feedback loops to achieve performance goals; and improving the identification of fraudulent scenarios through advances in data quality. Case studies will be presented detailing the information technology used, management processes developed, resources required, and the results of the investment.

11:00 AM - 12:30 PM 7F - You Don’t Have to be Einstein to Understand Radiation Oncology

Lashelle Walker, CPC, CPC-I
This presentation will cover the fundamentals of radiation oncology coding. We will begin with the E/M visit; follow through to the RT series of coding (including pecial modalities); review appropriate modifier usage; and close with a briefing of diagnosis sequencing for radiation oncology.

Breakout Session 8Back to top2:00 PM - 3:30 PM 8A - The Four Elements of Spine Coding

Barbara McBride, CPC
This simple, yet comprehensive approach to the process of spine coding begins with the concept of coding as its foundation. The operative note is then divided into four distinct sections, as a means of guiding the spine professional through the coding process step-by-step. The operative note will be examined and viewed in a new way, which will allow for easier, more accurate, and more efficient coding.

2:00 PM - 3:30 PM 8B - E/M Chart Auditing

Jane Tuttle, CPC, CCS-P, CPC-I
A brief overview of “the rules” for properly using each category of E/M service. Moves on to describe the specific details required for documenting E/M services, including all the necessary elements of the history, exam, and medical decision-making components. Actual practice chart audits will help attendees practice their skills at identifying these critical elements. Audit tools will be provided—bring your critical thinking skills!

2:00 PM - 3:30 PM 8C - Preparing for ICD-10-PCS

Sheri Bernard, CPC, CPC-H, CPC-P
ICD-10-PCS is the coding system slated to replace Volume 3 of ICD-9-CM for inpatient procedural coding. This dynamic system bears no similarity to Volume 3 or CPT® coding, and documentation requirements for physicians are intense. Payers and physician office staff interested in trouble-shooting for their physicians will be intrigued bythe ramifications of this ‘smart code’ system.

2:00 PM - 3:30 PM 8D - Health Care Fraud: Knowledge and Skills for the Coder

Joan Syler, CPC
Health care fraud schemes with actual medical record examples involving CPT®/ICD-9-CM codes, laws/regulations, and coder responsibilities will be evaluated for ethical and compliance issues when confronted with possible fraud issues.

2:00 PM - 3:30 PM 8E - Life in the ER: Understanding the Patient Flow in a Level One Trauma Center

David Kaplan, MD
Dr. Alarcon and Suzan Berman-Hvizdash will delve into the inner workings of a trauma center. The different levels of trauma will be illustrated, including the services provided by the trauma team, the specifics on how patients arrive in the ED, and how the documentation is generated and becomes a billable service. This will be an exciting and exhilarating session that cannot be missed by those involved in the emergency and surgical trauma environment.

2:00 PM - 3:30 PM 8F - Radiology for the Non-Radiologist

Terry Leone, CPC, CPC-P, CIRCC, CPC-I
A review of CMS and American College of Radiology guidelines for billing radiology procedures and guideline requirements for other specialties that are billing radiology technical component, professional component, or both from their offices will be followed by an open discussion for the attendees to raise their billing questions and office practices for billing radiology procedures.


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