Salary Survey 2012: Trends Show Growth and Diversification

Five-year comparison indicates consistent progress in this health care sector.

By David Blackmer, BA, and Brad Ericson, MPC, CPC, COSC

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Snapshots are instant slices of our lives. Compare them from year to year while placing them side by side and our lives become stories.

Every year, Coding Edge presents AAPC’s Salary Survey as an annual slice of data about our members’ welfare. This year, we decided to show you how the information trends through the years because it tells a very interesting story about our profession’s growth.

The 2012 AAPC Health Care Salary Survey, which was open to health care business professionals online this summer, confirms coders, billers, practice managers, auditors, and educators are in a dynamic environment. It is obvious the recession affected our industry, and for most members things are improving. But the unpredictable impact of market forces provides surprises.

A lot has happened since 2008, when our trend lines begin. A deep recession, beginning in December 2007, ended in 2009 with a slow recovery and rippling effect throughout the country. Changes to the mix of practice size and affiliation occurred. Major changes to the way federal and commercial payers could pay physicians evolved and were mandated. And, as AAPC grew from 60,000 members in 2008 to nearly 120,000 now, our professional roles, expertise, locations, and education diversified unimaginably.

A significant nod to the importance of our craft is that more than 25 percent of respondents said they have decision-making power in their work places, compared with less than 20 percent in previous years. This means AAPC members are gaining more credibility for knowledge and expertise.

How Much We Make

The 2012 average salary is $47,870, based on responses. This includes credentialed and non-credentialed members; but, when broken down by credential, the averages this year look like this:

• Certified Professional Coder (CPC®) – $47,796 (up nearly $900 from 2011)
• Certified Professional Coder – Hospital Outpatient (CPC-H®) – $56,466 (up nearly $1,800 from last year)
• Certified Professional Coder – Payer (CPC-P®) – $55,255 (up nearly $3,800 from last year)
• Certified Professional Medical Auditor (CPMA®) – $59,365 (up more than $3,200 over last year)
• Specialty credentials – $54,145
• All AAPC credentials, avg. – $48,033

Taking all of the credentialed respondents’ salaries and averaging them, we see that in the last two years salaries are slowly growing.

Salary by Workplace

Average salary by workplace has increased from last year by 9.7 percent or more for those in smaller groups or practices. Those working in facilities made more, but received less in raises comparatively, averaging between 4 and 5 percent. For example, as shown in the Salary by Workplace table, the average salary at a solo practice was $40,290 in 2010, $41,301 in 2011, and $45,312 in 2012 compared to the average salary in an outpatient hospital: $43,685 in 2010, $43,751 in 2011, and $45,399 in 2012.

Salary by Job Responsibility

As you can see in this next table, Salary by Job Responsibility, salaries are indeed affected by job responsibility, and educators are making the most money.

Credentials, Education, and Benefits

Credentials and education impact our salaries. How much education and what certifications we hold factor in to where we sit financially.

Credential Required

While slow, there is a definite trend toward employers requiring credentials. As you can see in the Credential Required table, 54 percent of employers require certification today, compared to 47 percent in 2008.

Salary by Experience

We know now that the average years of experience of credentialed members are significant. In our survey, CPCs® have 12; CPMAs® and CPC-Hs® have 14; and Certified Professional Coder—Instructors (CPC-Is®) have 19 average years of experience. As shown in the Salary by Experience table, salary reflects experience over the years, and salary increases follow suit.

It is discouraging to note that beginning coders’ salaries have not changed much in five years, while those with significant experience are seeing larger increases.

Education

Our education is less predictable from year to year. For example, salaries are larger depending on how much education a member has, but higher levels of education did not always see an increase in average salary in past years. Fortunately, as shown in the Education table, this year showed improvement for everyone, especially for those with a master’s degree or higher.

Those with an associate degree or some college make 9 percent more on average than those who have not attended college. Those who have a bachelor’s degree make 21 percent more on average than those with an associate degree or some college experience. Those who have a master’s degree or greater make 46 percent more on average than those who have a bachelor’s degree. Clearly education pays.

Education Breakdown

We are an educated group, according to the breakdown of respondents’ education level in 2012, as shown in the Education Breakdown table.

Unemployment

We’ve seen growth in members with bachelor’s and master’s degrees. We believe that much of this gain is based on an increasing number of providers becoming certified and members who are choosing this field as a second or third career. This led us to look at unemployment rates. As shown in the Unemployment table, the unemployment rate is up for CPCs® and those with AHIMA credentials, but still well below the national average of 8 percent. For apprentices (CPC-As®, CPC-H-As®, and CPC-P-As®) who are breaking into the field, employment has improved, but remains difficult, with rates close to 25 percent.

Workplace

We are seeing an upward trend towards facility employment, as shown in the Workplace table. This may be a reflection of many providers’ decision to sell their practices to facilities.

Benefits

What sort of benefits we receive fluctuates from year to year, as does the number of hours we work per week. More than half of respondents work an average of 31 to 40 hours a week. Around 40 percent work more than 40 hours per week. As shown in the Benefits table, employer-sponsored perks appear to be little changed over the past four years.

Where Do We Go from Here?

Interestingly, most of us are alright staying exactly where we are. The highest percentage of respondents (44 percent) indicate coding/billing was their long-term career goal. Auditing and practice management were the next top choices (about 16 percent each), with compliance and health information technology (HIT) trailing behind at 7 and 6 percent respectively.

Salary by Region

One of the most interesting year-to-year comparisons is of average salary by region. It is easy to see how the recession has moved through regions and when. Most heartening, though, is that for respondents in 2012 in all regions, salaries are up. Only 19 percent of us work in a rural area, while 37 percent work in a suburban location, and 44 percent work in an urban setting.

Salary by Region

Overall, since the advent of the recession of 2008, members have slowly grown their compensation and continue to do so.

David Blackmer, BA, is a marketing specialist at AAPC; Brad Ericson, MPC, CPC, COSC, is director of Publishing and Warehouse at AAPC.

September 20th, 2012

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ICD-10 Training: Get Help with A&P and Code Set

ICD-10’s implementation on Oct. 1, 2013 will change everything from the way health care providers document services to the way codes are selected, reported, and reimbursed. It forces medical staff to see computers as partners rather than simple tools. The advent of ICD-10 will homogenize practices, requiring all who come in contact with patients and their records to adapt. Yet, it will be coders who set the keystone for success.

Preparation Is Key
Imagine how you’d prepare for an elderly relative’s move to your house. You’d be anxious, for sure, but preparation would override that as you made decisions about the physical changes the house requires and alterations to your routines. The new member of your household would bring stress, but housing her must be done. Ultimately, the experience would make you grow, and maybe even a newfound appreciation would form. That’s why AAPC is putting so much time into helping you prepare. “ICD-10 is not just about coding,” Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, AAPC’s vice president of ICD-10 education, recently told attendees at the annual meeting of the American Academy of Otolaryngologists. “It changes everything about your practice. If you don’t make the transition to ICD-10 on time, you won’t get paid. It’s that simple.”

ICD-10, with 78,797 new diagnostic codes, may seem overwhelming, but its elegance is impressive. For example, ICD-10 codes for diabetes are more specific, helping to identify the care needed. Ilio-sacral joint problems, previously reported as unspecified lower back pain, now can be specifically coded and care better tracked. New specificity found in the codes will help make documentation for pay-for-performance and quality tracking programs much easier, Buckholtz says. Every form, procedure, policy, contract, or program will be affected as each of these is tied to diagnostic coding.

All Eyes on Coders
Americans like to do things bigger and better. It’s no wonder, then, that even though we are one of the last countries to adopt ICD-10, our clinically modified version expands 79,000 codes laterally to seven characters rather than the usual five used by other countries. Our ICD-10 is big. It means physicians and other health care professionals must provide detailed documentation so you can code to the greatest specificity.

The expected advantages of electronic health records (EHRs) aside, all eyes will turn to coders to make sense of ICD-10-CM and ICD-10-PCS, Buckholtz tells Coding Edge. Central to success is a better understanding of anatomy and pathophysiology (A&P), Buckholtz says, cautioning even the savviest coders to strengthen their knowledge of A&P. The specificity of ICD-10 codes is based on a  precise identification of body sites and function. Not only will you need to know that, but you will also need to help your provider understand why detailed documentation is necessary, she says. AAPC provides a number of resources—Web-based, live, and printed—to help you lead your practice into this new way of managing the data and revenue of patient care. You can access information on ICD-10 implementation, 5010 electronic transaction standards, and other coding facets through a number of avenues.For the last two years and through this August, AAPC has been helping practices, payers, and facilities prepare for ICD-10 implementation. Beginning in September 2012, code set training will be everyone’s focus.

Training Steps to 2013
Buckholtz outlines a five-step process to ICD-10 implementation, which can be found at www.aapc.com on the ICD-10 tab. Here you will find explanations for the various training tools and a tracker to help you gauge your preparedness and get your practice ready. AAPC also offers to members a free ICD-9 to ICD-10 code conversion tool based on the Centers for Medicare & Medicaid Services’(CMS’) general equivalence mappings (GEMs) files. Simply enter an ICD-9 code to see the ICD-10 code(s) equivalent.

ICD-10 Implementation Training – AAPC offers a two day boot camp or on-site training for larger organizations, outlining all the steps and resources needed to switch to ICD-10-CM and ICD-10-PCS. These boot camps are held all over the country and attendees leave armed to prepare.

A&P – This 14-hour, online, advanced training will strengthen your A&P knowledge so you can feel confident in your ICD-10 code selection. This will help you earn up to 14 CEUs.

Clinical Requirements in ICD-10 – This online program will help your provider fine-tune documentation to meet the rigid standards ICD-10 will demand.

ICD-10-CM General Code Set Training – This code set and guidelines training begins in September this year with online or boot camp training. Hands-on exercise will help attendees feel more confident about the upcoming change as they become familiar with the new system. Training will be offered as workshops and online. Conferences in 2013 will include general code training.

ICD-10-CM Specialty Code Set Training – Beginning January 2013, specialty code set training will help coders see the impact ICD-10-CM will have in a particular setting. ICD-10 will, for example, affect cardiology differently from pediatrics.

Online Proficiency Prep Tool – Available in September, this online tool will help coders prepare for ICD-10 with case studies, practical exercises, and tips for passing their proficiency assessment.

Proficiency Assessment – Prove ICD-10 expertise to colleagues and providers by taking this 75-question exam before Sept. 30, 2014. Certified coders should complete this exam to maintain their status as elite coders.

More ICD-10 Resources
AAPC already offers and is developing several tools to make the transition easier.

ICD-10 Fast Forward – These inexpensive, laminated sheets include crosswalks from ICD-9-CM to ICD-10-CM for the top 50 diagnoses for 15 specialties. Learn of frequently-used codes in your specialty that will change, and use the cards to help develop new superbills and train others in your practice.

ICD-10 Code Books – AAPC will offer the final code set with guidelines you can use as a learning and documentation assessment tool beginning early 2012.

Local Chapter Training – Local chapters have two options: Easily accessed chapters can request a visit from a National Advisory Board (NAB) member or one of the AAPC Chapter Association (AAPCCA) Board of Directors members. For those where travel is difficult or who can’t wait, download an ICD-10-CM and ICD-10-PCS presentation from the local chapter page at www.aapc.com.

Webinars and Workshops – ICD-10-CM/PCS is part of AAPC’s regular educational fare. Take advantage of on demand webinars or the latest in on-demand workshops, such as November’s “ICD-10, What You Need to Know Now!” by Kim Reid, CPC, CPMA, CPC-I, CEMC. Free resources and costs for training can be found on www.aapc.com. According to Buckholtz, “AAPC is trying to provide as much I-10 support and training in the most affordable, effective, and accessible ways possible. We want our members to be the leaders in I-10 adoption at their workplaces because nobody can code like an AAPC member.”

January 10th, 2012

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Health Care Reform Law To Be Addressed By Supreme Court

The Supreme Court said Monday it will hear arguments next March over President Barack Obama’s health care overhaul.

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November 15th, 2011

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Get the Latest on Abdomen and Pelvis CT Scan Codes

Computed tomography (CT) uses computer imaging and multiple, narrow beams of X-rays to produce thin, cross-sectional views or images of various body layers. These images allow visualization of soft tissue, as well as bones, making them useful for evaluating a wide range of conditions.

 CT imaging of the abdomen and pelvis frequently are performed together during the same encounter. The combined services are useful for evaluating a large number of conditions, including abdominal and pelvic pain; infections such as appendicitis or diverticulitis; inflammatory processes such as ulcerative colitis; and cancers of the colon, liver, kidneys, pancreas, and bladder. Combined CTs of the abdomen and pelvis also are performed to quickly identify internal injuries in cases of trauma.

During CT of the abdomen, the organs visualized include: the liver, spleen, kidneys, pancreas, the top half of the large intestine, the small intestine, and the superior aspect of the ureters. During a CT of the pelvis, the organs visualized include: the remainder of the large intestine, the small intestine, and ureters, as well as the bladder, uterus, and ovaries.

Combined Services Call for New CPT^® Codes

Prior to 2011, two CPT^® codes had to be selected to reflect the combined services when CTs of both the abdomen and pelvis were taken during the same encounter. Because of an increased frequency of these services performed during the same encounter, the American Medical Association (AMA) developed three new CPT^® codes for 2011 that reflect current practice.

Use these codes for a CT of the abdomen alone:

74150      Computed tomography, abdomen; without contrast material

74160      Computed tomography, abdomen; with contrast material(s)

74170      Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 

Use these codes for a CT of the pelvis alone:

72192      Computed tomography, pelvis; without contrast material

72193      Computed tomography, pelvis; with contrast material(s)

72194      Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections

The following codes should be used only if both the abdominal and pelvic CT are performed during the same encounter.

74176      Computed tomography, abdomen and pelvis; without contrast material

74177      Computed tomography, abdomen and pelvis; with contrast material

74178      Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions

The AMA includes a table in CPT^® 2011 (see Table A) to help you determine the correct code.

Table A

Table A illustrates that CPT^® 74176 should be used only if both studies are done without contrast. Use CPT^® 74177 only if both studies are done with contrast.

Code 74178 should be used in two situations:

• One or both studies are done without contrast, followed by contrast material(s) and further sections.
• One study is done without contrast, while the other study is done with contrast.

Scenarios Help Show Correct Coding

Example one: A 34-year-old male presents with 48 hours of lower abdominal and pelvic pain. The patient also has a low-grade temperature. His physician orders a CT of the abdomen and pelvis without intravenous contrast. The radiologist supervises the process of providing the CT, and then interprets the images acquired. He also dictates a report of his findings. The radiologist should report 74176.

Example two: A 48-year-old female presents with flank pain and persistent gross hematuria. The patient’s urologist conducts a cystoscopy and is unable to identify the cause of the patient’s symptoms. He orders a CT of the abdomen and pelvis without and with intravenous contrast. The radiologist supervises the process of providing the CT, and then interprets the images acquired. He also dictates a report of his findings. The radiologist should report 74178.

Coding tips to remember:

• If both a CT of the abdomen and a CT of the pelvis are performed during the same session, use one of the new codes that describes that combination of services (74176, 74177, and 74178).
• Refer to the table provided in the CPT^® book to determine the correct code.
• Report 74176, 74177, or 74178 only once per session.
• Codes 74176, 74177, and 74178 can never be reported together with any of the codes for CT of the abdomen alone (74150, 74160, and 74170), or CT of the pelvis alone (72192, 72193, and 72194).

Nancy Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC, has over 20 years of experience in the health care industry and is a manager in the Corporate Compliance department at Carolinas Healthcare System in Charlotte, N.C. Nancy is past president of the Charlotte, N.C. Local AAPC Chapter and was AAPC’s 2009 Coder of the Year. She can be reached at nancy.higginscpc@yahoo.com.

August 18th, 2011

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Two Criteria Determine DVT and Venous Emboli Dx

By Sara Wolf, BA, CPC-H, CCS, and G. J. Verhovshek, MA, CPC

Deep vein thrombosis or deep venous thrombosis (DVT) describes the formation of a blood clot (thrombus) in a “deep” vein. The condition is most common in the large veins of the lower extremities (for example, the femoral vein), but may occur in veins of the upper extremities, as well.

DVT may be asymptomatic, but more frequently exhibits symptoms of pain, swelling, and discoloration in the affected extremity. Three broad mechanisms—called “Virchow’s triad” in honor of German physician Rudolf Virchow—are the primary causes of DVT:

1. Decreased blood flow

2. Damage to the wall of the vein

3. Increased blood clotting (hypercoagulability)

Many specific circumstances may contribute to the formation of DVT. Recent surgery—especially hip, pelvic, or prostate surgery—is a risk factor (See “DVT Linked to Surgery Calls for Unique Coding” for more information.), as is inactivity, obesity, smoking, a history of cardiovascular disease, or other medical conditions ranging from cancer to bone fracture. Women who are pregnant or who have been pregnant recently are more prone to DVT, as are those who use estrogen or oral contraceptives.

Verify Criteria to Determine Codes

ICD-9-CM groups DVT by two criteria: vein location and chronic vs. acute. The determination of chronic vs. acute must be made by the documenting provider, based on the clinical evidence. For example, the diameter of a vein as measured by duplex scan may increase in acute conditions, but will decrease to less than normal over time.

Chronic vs. Acute: Make the Distinction

Here are the acute and chronic DVT codes for upper and lower extremities:

DVT Lower Extremities

• Acute: femoral, iliac, popliteal, and vein of thigh or upper leg not otherwise specified (453.41 Acute venous embolism and thrombosis of deep vessels of proximal lower extremity)
• Acute: peroneal, tibial, and vein of calf or lower leg not otherwise specified (453.42 Acute venous embolism and thrombosis of deep vessels of distal lower extremity)
• Acute: unspecified vein of lower extremity and DVT not otherwise specified (453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity)
• Chronic: femoral, iliac, popliteal, and vein of thigh or upper leg not otherwise specified (453.51 Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity)
• Chronic: peroneal, tibial, and vein of calf or lower leg not otherwise specified (453.52 Chronic venous embolism and thrombosis of deep vessels of distal lower extremity)
• Chronic: unspecified vein of lower extremity (453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity)

DVT Upper Extremities

• Acute: brachial, radial, and ulnar vein (453.82 Acute venous embolism and thrombosis of deep veins of upper extremity)
• Chronic: brachial, radial, and ulnar vein (453.72 Chronic venous embolism and thrombosis of deep veins of upper extremity)

Note that the default code for DVT of an unspecified site is 453.40. ICD-9-CM also contains codes to report embolism/thrombosis of superficial and/or other specified (not deep) veins (e.g., 453.6 Venous embolism and thrombosis of superficial vessels of lower extremity and 453.76 Chronic venous embolism and thrombosis of internal jugular veins).

The distinction between acute and chronic is important because patients with DVT may require anticoagulant therapy for six months or more; an acute diagnosis would support initiation of such therapy, while a chronic diagnosis would support its continuation. Code V58.61 Long term (current) use of anticoagulants may be reported in addition to the code describing the DVT if the patient currently is undergoing anticoagulant therapy.

If a patient has a history of venous thrombosis that is no longer present, you may assign personal history code V12.51 Personal history of venous thrombosis and embolism, pulmonary embolism.

PE Complicates DVT and Coding

An embolism occurs when a thrombus dislodges and is carried by the circulatory system to a different part of the body. The clot travels through progressively smaller vessels until it becomes stuck in place. An embolism resulting from DVT most often affects vessels of the lungs after traveling through the heart. This is called a pulmonary embolism (PE), and it may result in labored breathing, chest pains, and even death.

An acute PE may be reported from ICD-9-CM category 415.1x Pulmonary embolism and infarction. Note that septic pulmonary embolism code (415.12 Septic pulmonary embolism) requires you to sequence the underlying infection before the PE code. Chronic PE is reported using 416.2 Chronic pulmonary embolism.

 Sara Wolf, BA, CPC-H, CCS, has nearly 30 years of coding experience. She is executive director for ZHealth, providing coding consulting and reimbursement evaluation for facility and physician services.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC.

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