Career Step, LLC Winter 2013

Career Step Quality Training • 4692 N. 300 W. Suite 150 • Provo, UT 84604 • www.careerstep.com • Ph: 800-246-STEP

Graduates . . . . . . . . . . . . . .2

Proofreading . . . . . . . . . . 3

Graduate Spotlight . . . . 4

Dear Cari . . . . . . . . . . . . . . .5

MedicalCODING

Bulletin

Selection of Principal ProcedureIn the fourth quarter in 2012, AHA

released a Coding Clinic with an important clarification to ensure coders are correctly assigning the principal procedure. Prior to this coding clinic, the definition of the principal procedure was ambiguous and open to interpretation. This is important because the assignment of the correct principal procedure can affect the DRG that is assigned. This in turn can affect the reimbursement that is provided.

This coding clinic provides the following four instructions for the selection of the principal procedure.

1. Procedure performed for definitive treatment of both principal diagnosis and secondary diagnosis

Sequence procedure performed for definitive treatment most related to principal diagnosis as principal procedure.

2. Procedure performed for definitive treatment and diagnostic procedures performed for both principal diagnosis and secondary diagnosis

Sequence procedure performed for definitive treatment most related to principal diagnosis as principal procedure.

3. A diagnostic procedure was performed for the principal diagnosis and a procedure is performed for definitive treatment of a secondary diagnosis

Sequence diagnostic procedure as principal procedure, since the procedure most related to the principal diagnosis takes precedence.

4. No procedures performed that are related to principal diagnosis; procedures performed for definitive treatment and diagnostic procedures were performed for secondary diagnosis

Sequence procedure performed for definitive treatment of secondary diagnosis as principal procedure, since there are no procedures (definitive or non-definitive treatment) related to principal diagnosis.

It is also important to be familiar with the definition of the principal diagnosis to assist you in selecting the correct principal procedure. The definition

of the principal diagnosis is: the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. When a medical coder correctly assigns the principal diagnosis this will help in determining the correct principal procedure.

The opposite of this is also true. The assignment of the incorrect principal diagnosis can lead to the assignment of the incorrect principal procedure. As mentioned earlier this can affect the reimbursement that is provided. Because of this, it is essential that a medical coder assign the correct principal diagnosis and principal procedure. Incorrect assignment of these can lead to higher

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Winter 2013 MEDICAL CODING BULLETIN2

GRADUATESBethany Seidman – Vineyard Haven, MABefore signing up for the course, I researched other companies’ online programs. Although Career Step was more expensive then the other programs, it appeared more credible. I guess it comes down to “you get what your pay for,” because the Career Step program was well worth it. It definitely covered the material in depth and support was just a call away. I especially liked that I could access the program at anytime. The ability to set up a study plan with expected completion dates for each unit was the best motivator for me. The fact that you could take the final exam 3 times, even though you had already passed, was a plus in practicing for the AAPC CPC certification exam (which by the way, I passed on my first attempt on Dec 1, 2012). It wasn’t easy and I’ve never experienced such a grueling test, but I can’t imagine passing it if I hadn’t taken the Career Step course first. I love the supportive staff too. Looking forward to the next step of preparing my resume and getting a job. Will be in touch soon. Thanks again.

Diane H Miller – Jackson, MSI really enjoyed my studies and training. Being in class again took some adjusting and getting use to, but it was easier to be able to do it online. My experience and training was great. In order to be successful, you have to be dedicated and focused. That’s what helped me through the class --staying focused and refusing to give up when some of the lessons became a little challenging. I cannot stress to you enough that you have to focus and want to succeed. I am so thankful for Career Step. Thanks.

Georgia Hannon – Phoenix, AZI found the program to be more involved than others I had researched. Coming at this from an insurance background gave me insight into what billers and coders went through prior to submitting their claims

for adjudication (which is where I came in). Now I have this knowledge to use if I decide to go back to my former line of work. The support staff was always very helpful whenever I got stuck.

Jeanette Greene – Cooper City, FLI just wanted to say that, thanks to the great training at Career Step, I passed my CPC exam on the first try. It only took me two months to get my first coding job. I was also told that my employee entrance exam was one of the better ones they had come across in a long time. I owe it all to the intense and complete training in all facets of coding from Career Step. Everyone was great and so supportive. The resume review also gave me a great edge and I couldn’t have done any of it without the great support staff. I am forever grateful to all of you.

Layla Lowman – Hickory, NCCareer Step and all of the staff worked with me and answered all of the questions I had. I definitely recommend the program! They have even kept in touch with me on my journey to find employment!

Mark Sandifer – San Tan Valley, AZI recently graduated with honors from the Career Step curriculum. I chose the medical coding for inpatient and outpatient services. I am currently scheduled to take the AAPC CPC exam in January. After researching the CPC criteria and acquiring some practice materials, I feel Career Step has positioned me to be successful in taking the test. I chose Career Step because it was highly recommended and it provided me the opportunity to pace myself at my convenience. The program provided significant information in all the required fields of study and the hands-on coding scenarios were actual case records. I am very pleased with the Career Step organization and program and I am sure others will be who enroll. Thank you Career Step.

Sharon Clarke – Pearl River, NYCareer Step definitely provided the tools to succeed in the medical coding world. With a little prep I passed the CPC (AAPC) exam on my first try! I am now studying for the CCA (an unknown entity for me!). Through Career Step’s association with AHIMA, I have obtained a mentor and an internship for 2013. While it is very tough to break into the medical coding world, I feel confident that my education has been superior to many other programs I’ve heard about. With my internship experience I hope to be in a good position to embark on my new career!

Stacey Hrabak – Lisbon, IAI was very pleased at how much I learned throughout the program. I feel well prepared for my new career. The Career Step staff not only supported me through the program, but is continuing to support me in my job search! I am very excited at taking this next step!

Wanda Lockamy – Fayetteville, NC I enjoyed the class and found it very rewarding. I learned a lot. I look forward to my new career.Thanks.

Yan Yang – Columbia, MO I liked this self-paced program because I controlled when I studied. I absolutely learned a lot and the support team is wonderful. Anytime I asked questions about my homework or other stuff, they answered them in a timely manner. I graduated on time. I think the fact that the test can be taken repeatedly is good too. Unfortunately, I have not taken the certification yet because my current job is stable, but I will go for the certification as soon as I can. Thanks for providing the program to give me another chance to work in a new field. Thanks again.

Career Step Congratulates Our Recent Graduates Alicia - Joint Base Lewis McChord, WAAlicia - Tacoma, WAAmalia - San Diego, CAAmy - Fort Stewart, GAAndrea - Pottstown, PAAndrea - Visalia, CAAshley - Cameron, NCAshley - Seattle, WAAshley - Monticello, ARBethany - Vineyard Haven, MA

Brianna - Roscoe, SDBrittney - Pensacola, FLCarrie - Moira, NYCharlotte - Huntsville, TXChristopher - Fayetteville, ARCourtney - Rock Hill, SCDaniel - Sioux Falls, SDDiane - Jackson, MSEileen - Port Jervis, NYElizabeth - Fountain Valley, CA

Erin - Sheridan, WYFinis - Fayetteville, NCGayla - Elko, NVGeorgia - Phoenix, AZGreg - Yucaipa, CAHolly - Scott Depot, WVJeanette - Cooper City, FLJeanne - Johnston, RIJenna - Ft . Wainwright, AKJennifer - FPO, AP

Jessica - Dade City, FLJessica - Highland, UTJoAnna - Longwood, FLJoe - Fort Worth, TXJosephine - Townville, PAJudith - Hope Mills, NCJudy - Bayville, NJJulie - Sauk Rapids, MNKathleen - Sandusky, OHKathy - Perrysburg, OH

MEDICAL CODING BULLETIN Winter 2013 3

Congratulations to those that have recently reported passing a certification examination! 7/1/12 to 9/30/12

Daisy Portante - 9/22/12 - CPCDana Chock - 8/18/12 - CCADanica Mills - 7/14/12 - CPCDenah Shirey - 7/30/12 - CPCJeanette Greene - 9/22/12 - CPCJessica Pate - 7/1/12 - CPCJodie Brown - 7/21/12 - CPC

JoEllen Rivera - 7/28/12 - CPCJolynne Manfredonia - 9/8/12 - CCAJulie Dylla - 9/22/12 - CPCKatherine Root - 8/11/12 - CPCKimberly Dunn - 9/15/12 - CPCKortnee Saccoman - 9/22/12 - CPCLatasha Biggers - 9/15/12 - CPC

Laurie Waldman - 7/28/12 - CPCLisa Simpson - 8/18/12 - CPCLori Baker - 7/1/12 - CPCMary Taylor - 7/1/12 - CPCPuspalata Sahoo - 9/22/12 - CPCRobert Ruiz - 7/19/12 - CCSSarah Hoyle - 7/12/12 - CCA

Seema Bapat - 7/10/12 - CPCStephanie Lange - 8/18/12 - CPCSusan MacDonald - 8/28/12 - CCAThomas Swinford - 9/20/12 - CCAWarren Gabrillo - 7/1/12 - CPC

Kaylor - Clarksville, TNKortnee - Jerome, IDLauren - Killeen, TXLayla - Hickory, NCLinda - Williamstown, NJLinda - Jacksonville, NCLinda - Hendersonville, NCLisa - Marshville, NCLoretta Michele - Dallas, TXMark - Chandler, AZMarwa - Manhattan, KS

Mary - Cameron, NCMary - Durham, NCNeal - Maybrook, NYOksana - Goldsboro, NCPaigge - El Paso, TXPam - Sioux Falls, SDPaula - Monument, COPerla - Fallbrook, CARaymond - Chicago, ILRhonda - Fayetteville, NCRobert - Turnersville, NJ

Rupalatha - Tempe, AZSarah - Silverdale, WASharilee - Centerville, GASharon - Pearl River, NYSharon - Littleton, COStacey - Lisbon, IASteffen - Mesa, AZStephen - Port Charlotte, FLSue - American Fork, UTSusan - Rhinelander, WIThea - Junction City, KS

Theresa - Richfield, MNThomas - Lafayette, INToni - Gahanna, OHTraci - Hanover, PAWanda - Monroe, NCWanda - Fayetteville, NCYan - Columbia, MOYuliana - Evans Mills, NY

The Improtance of Profreading;Attention to Detail

Chances are the title of this article immediately caught your eye. You

may have discounted the editor of this issue or Career Step’s attention to detail.

Although these particular spelling errors were intended, mistakes leave an impression, whether you intend them or not, and that negative impression is not one you want to define you. For that reason, now is the time to establish habits of accuracy that build the professional reputation you want following you through your life and career.

How Are Your Emails?

Even as a student, you can practice professionalism in the emails you are writing and sending. Be sure to capitalize your sentences and use correct grammar and punctuation. Spell check and read through the content of your emails

before you send them. Avoid graphics, clip art, or anything that would be distracting to the body of the email. Font color should be a standard color (blue or black) and font size should be easy to read. By implementing these practices in your personal emails now, you will make professionalism a habit to avoid future errors in professional correspondence.

Some individuals like to have a tag line, phrase, or quote as part of their email signature. Although this is fine for personal emails, you may want to remove it or be sure that it gives the impression you would want to make to an employer. This small note can make a big impression to an employer.

How’s Your Email Address?

Even if the body of your message is professional, one of the first things the recipient sees when you email them is

your email address. Be sure your email address is professional and simple. If your personal email does not sound professional, it may be time for a new one. For example, if your email address is beachbum37@gmail.com, you might considering changing it to something like john.smith37@gmail.com. You may also consider creating a new professional address that you use specifically for job applications. Be sure that your email address is tied to your name and one that you check often; you wouldn’t want to miss an email from a potential employer! You will want to show an employer, even as an applicant, that you are prompt in replying to any information or questions they have for you.

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Winter 2013 MEDICAL CODING BULLETIN4

I’ve been an at-home transcriptionist since my son was born six years

ago. One report was an interview with someone talking about medical coding as a work-at-home profession. Transcription work is adequate, but with electronic medical records becoming more common and the fact that my little man was becoming a bit more independent, it seemed like an opportune time to branch out and acquire another skill set. After an exhaustive investigation of several online coding courses and discussing the matter with my very supportive husband, I decided to enroll with Career Step in May 2011.

The first part of the course was a breeze, but because it was easy, I’d let work and other things get in the way, being overconfident that I would be able to catch up when other parts of my life slowed down. I’d study sporadically for a couple of weeks and then let it go for another three or four.

Then, in January of 2012 life threw us a curveball: our second child would be born in August, when I’d already have reached the ripe old age of 44. This, combined with homeschooling our little man, keeping my transcription clients happy, and helping my sister take care of our mom, who has Alzheimer’s, pushed my studies further behind. Before I knew it, I only had two months before my program expiration date and I hadn’t even started the practicum.

I calculated the number of reports in the practicum, divided it by the number of days I had left to complete the course and made it my goal to do that number of reports per day. There were times that work and family obligations still got in the way, but I’d try to double up on other days to make up for it. Unfortunately, this meant that I wasn’t getting the full benefit of the learning experience because I was basically speeding through, clicking answers, skimming the

rationale for the ones I got wrong, and moving on.

Fast-fowarding to May 2012, I left myself a week to prepare for the Career Step final. I passed, but one point shy of graduating with honors. I then ordered the AAPC Study Guide, scheduled myself for the CPC exam on 7/28/12 and repeated my original mistake. I had planned to cover six pages of the study guide per day to finish the whole book by the end of July. However, after starting the first few chapters, it sat until I was three weeks away from the exam date and I found myself flying through the material trying to cover it all in time.

There I sat at the exam site, a week and a half away from my due date, hoping that test anxiety wouldn’t send me into labor. By the time there were only five minutes left on the clock, I still had about eight questions to go. Since they told us that any answer is better than none, I

Graduate in the SpotlightJoEllen Rivera, CPC-A

How’s Your Voicemail?

Be clear in stating your name and be sure there isn’t background noise when you are recording. Although it can be cute to have one of your children record your voicemail or fun to trick your friends, you do not want that same voicemail to be what an employer hears when they contact you. Keep your message short, simple, and to the point. If you use a personalized ring back tone, be sure that is professional as well.

How’s Your Social Media?

It’s not uncommon for a potential employer to look you up on LinkedIn, Facebook, or Twitter if you already have an account or profile set up with one of those social networking sites. What you have posted there can create an impression for a potential employer.

Even on those sites, you need to make sure that your punctuation, spelling, and grammar are accurate. You may also consider changing the privacy settings so that a public user does not have access.

How’s Your Resume and Cover Letter?

Proofreading is especially important when it comes to professional documents that represent you, such as your resume and cover letter. The information included in these documents should be clear to read, and you should remove any details that are unprofessional or unrelated to the position for which you are applying. Neither of these documents should be in color, nor include any pictures. Just like your emails, you should be extremely careful to use a spellchecker and read through these documents before sending, printing, or distributing them.

Even though you are studying to become a coder and not an editor, editing will certainly come into play on a regular basis in your position as a coder. Being able to recognize and edit errors in the way a record was coded or billed is a valuable skill—essential to the profession. Accuracy is expected as a fundamental necessity of this career. There is no reason you can’t begin practicing these skills now!

We are all human, and we all make mistakes. A typo may slip its way into a document every now and then, and by itself, will not slander your image forever. Even so, establishing good habits now to ensure accuracy will help you to build a positive career image and help you in a lifelong pursuit of excellence.

- CS Graduate Support

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MEDICAL CODING BULLETIN Winter 2013 5

Dear Cari...Dear Cari,

I am having trouble applying the rule of nines and the coding of burns by extent of body surface involved. Can you provide me some direction on the proper code assignment of codes from category 948 for the following scenario?

Diagnosis: Patient with first, second and third degree burns on the chest and both arms. Additionally, patient has first and second degree burns on the abdomen and the front of both thighs.

Thanks for your help,

- Speculating in Seattle

To create a valid code for the preceding diagnosis the first thing we need to do is determine the correct 4th digit. We do this by estimating the percentage of body surface involved in all degree of burns. The patient had 1st, 2nd and/or 3rd degree burns of; the chest, both arms, the abdomen and the front of both thighs. Below is a breakdown of the estimate of extent of body surface involved for each site. (You may want to refer to the “Rule of Nines” chart found at category 948 in the Tabular List of your ICD-9-CM).

Chest = 9%Arm = 9% per arm X 2 = 18%Abdomen = 9%Anterior thigh = 5% (ap-prox) x 2 = 10%

(The anterior leg in its entirety equals 9%. The thigh is only the upper half of the anterior leg. Half of 9% is 4.5%. However, since the thigh is larger than the lower leg we add an addi-tional .5% to account for the difference. Remember, this is an estimate, not an exact number but the estimate should make sense).

The total of the percentages of body sur-face involved in all degrees of burns is, 46%. When you check the code options for code category 948 the code with the 4th digit that reports burns of all degrees

covering 46% of the total body surface is code, 948.4x; Burns classified according to extent of body surface involved, 40-49 percent of body surface.

In order to make a complete code, we still need to assign the appropriate 5th digit based on the percentage of the body surface involved in 3rd degree burns only. The diagnosis indicates the patient had 3rd degree burns of the chest and both arms. If we refer to our rule of nines, the percentages look like this.

Chest = 9%Arm = 9% per arm X 2 = 18%

The total of the percentage of body surface involved in 3rd degree burns is 27%. When you check the 5th digit options for code category 948 the 5th digit that reports burns of 3rd degree involving 27% of the total body surface is “2”. The assign-ment of this digit completes our code and we would report code, 948.42; Burns classified according to extent of body surface involved, 40-49 percent of body surface, 20-29%.

I hope that simplifies the coding of burns by extent of body surface.

Best of Luck!

- Cari Greenwood, CCS, CPCCS Coding and Billing Support

Dear Speculating,

One of the keys to reporting codes from the 948 category is to remember that the 4th digit reports the percentage of burns of all degrees (1st, 2nd and 3rd) from burn all sites and the 5th digit reports only the percentage of burns of the 3rd degree from all sites. (This means we will be counting the percentage of 3rd degree burns twice. Once in combination with 1st and 2nd degree burns and once all by itself )

The rule of nines is a tool to help us esti-mate the percentage of the body surface involved in burns if the documentation does not report a percentage provided by the physician.

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just read through the last questions and guessed. When I logged onto the AAPC site at the end of that week, seeing the skin-of-my-teeth passing grade brought an audible sigh of relief – not great but it sure beat scheduling a retake! What I learned the hard way is this: Don’t demand perfection, but do set reasonable goals and be disciplined about meeting them. Studying X number

of pages per day was just as important as meeting my transcription clients’ deadlines each morning and getting dinner on the table every evening. Also, if your budget allows, buy the practice exams. I thought I could get by with just the study guide, which was a valuable resource, but since I hadn’t taken a practice, my pace was off during the test. I was too slow in the beginning and ended up marking random answers by the end.

Even though I didn’t graduate with honors or ace the certification exam, there are two things I know for sure: 1) I’ll be the oldest mom on the playground; and 2) If you can soldier on through the inevitable feelings of ineptitude and discouragement, you will replace them with a priceless sense of achievement and personal satisfaction.

- JoEllen Rivera, CPC-A

4692 N. 300 W. Suite 150 Provo, UT 84604

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The Coding Bullletin is published quarterly by Career Step for its students, graduates, and client partners.

This newsletter is produced for electronic viewing. The electronic version is available to all current students and graduates at no cost.

Career Step Quality Medical Coding Training

4692 North 300 West, Suite 150Provo, UT 84604

Phone: 800-246-7837 or888-657-5752

Fax: 801-491-6645Website: www.careerstep.com

Jenae Walker, Editor-in-ChiefAlison Stapley, Associate EditorKelsi Hansen, Associate EditorAlesa Little, Layout Editor

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or lower reimbursement for the services provided to the patient.

In order to correctly assign the principal diagnosis and principal procedure, the medical coder needs to review the entire inpatient record. You cannot take shortcut when you are coding inpatient records. There are examples about the assignment of the principal procedure in

the fourth quarter AHA Coding Clinic for ICD-9-CM. We encourage you to review the examples in this coding clinic to get a better understanding of the correct assignment of the principal procedure. Continued best in your coding!

- Randy JohnsonCS Coding and Billing Support