Posts Tagged ICD-9

Create Compliant Templates in Your EHR

Moving forward with implementation means your participation is vital.

If you thought the introduction of the electronic health record (EHR) would change coding, you were absolutely right. The days of sitting in the back office, appending ICD-9-CM codes to paper fee tickets and manually posting charges is, for some practices, in the distant past. Modern offices expect you to transform your coding knowledge into the fundamental tools used for EHR software development and compliance auditing. With a systematic plan, the right resources, and reasonably sophisticated EHR software, you can be a vital resource in their implementation.

Get Ahead of the Learning Curve

To participate in the development of compliant documentation templates, you must understand how an EHR is designed and how software is modified.

Overall, the EHR should interface with a billing or practice management software so patient demographics data attach to the medical record to avoid ‘wrong patient’ issues. Most EHR software is designed with pre-created templates used to capture patient medical data, document visits and procedures, order prescriptions, and document patient/provider communication—all seamlessly linked to the patient demographics. These templates are designed so providers can enter data through several methods. They can click check boxes or select radio buttons, and choose items from drop down menus to determine the information they want to document in the patient chart. The provider can type additional data within a text box, which displays this information exactly as it’s entered. Other patient data, such as chronic conditions, past medical history, and medication lists can be pre-loaded.

In some sophisticated software, templates can be set up to require some sort of action—almost like an internal email that alerts nursing staff to contact the patient regarding lab results. Other templates can be developed to order a prescription that automatically faxes to the pharmacy. These methods of selection and documentation are elements of a “user interface,” which is a behind-the-scenes mapping of how and where the information is displayed. Taking the time to learn about the behind-the-scenes default “language” that is all part of the EHR package’s user interface will help you determine whether there are options for clear and concise documentation, or if the documentation is limited to certain canned phrases and verbiage.

All EHR software arrives “out of the box” with default data lists that are used to populate the templates to drop pre-determined verbiage into a formatted document based on the provider’s selection. These data lists can include CPT® and ICD-9-CM codes, and place of service (POS) indicators, as well as more customized and editable lists such as office locations, special charges, and fee schedules. Data is typically selected through a drop-down menu.

In all cases, successful EHR implementation depends on the ability to understand, customize, test, and audit the capability and compliance of the EHR software. Coders, today, need to understand the concepts of a user interface, billing rules, and clinical documentation standards, and be able to translate coding and documentation guidelines for successful and compliant software development.

Test the EHR Before Going “Live”

A good software package will provide you with a test environment. When the practice decides to “go live” with a new EHR, there is a period during which the electronically-generated medical record should be systematically audited within a test environment to identify errors or bugs. These problems should be corrected prior to using the EHR in a “live” environment.

By comparing the computer generated notes against an approved audit tool, you can see where the software might be “double-dipping” (counting the same elements twice), pulling forward (bringing arbitrary documentation from another, unrelated note), or creating “bugs,” such as documenting both male and female system reviews for all patients. The completed EHR should meet all of the criteria for a legal medical document. This kind of testing is most effective if planned and implemented in a methodical manner, using test patients that you create, name, and run through the workflow process with varying visit types and medical scenarios.

Using a spreadsheet or database to capture and compare this analysis process is helpful, and can keep the project organized. Some scenarios to consider include:

  • Are the templates for physical examinations age/sex appropriate?
  • Are there opportunities to document all elements of the history of present illness (HPI)? The review of systems (ROS)?
  • Are the examination templates set up to record based on 1997 or 1995 guidelines?
  • Can your medical record be locked for security after a certain length of time? What is your addendum process?
  • Can you import data such as lab results that are relevant to your current note? Is your note readable? Do consecutive notes appear to be copied, or cut and pasted?
  • Do surgical/procedural templates allow for informed consent documentation?
  • Is there space to document adverse effects or complications?
  • Does your finger stick glucose lab template always default to a diabetes diagnosis? This should not be the case: Not everyone is diabetic!
  • Does your wart destruction template allow for both benign and malignant lesion reporting?

Much of this developing and testing should be handled by your practice’s information technology (IT) department, but savvy coders, such as yourself, may want to develop super-user status. You can participate in pre-implementation activities, where you act as patients while the providers learn the software. During this time, make recommendations regarding coding compliance to the physicians, as well as the IT team.

EHR Software Works Best when Customized

The features that make an EHR easy to use, such as pre-filled templates, automatic code drop, and pre-determined diagnosis codes are the very things that cause compliance concerns. Think of the EHR as a tool that has to be sharpened and honed. It’s very effective if used correctly, but you have to learn how to use it safely, or you’re going to get hurt.

Most EHR software comes with pre-loaded E/M templates, which vendors probably will tell you are of the “plug and play” variety. Information systems experts and coders know that this is not necessarily the case. The Centers for Medicare & Medicaid Services (CMS) has not changed the E/M guidelines since 1997; however, the way the EHR captures data to support the levels of service has most definitely changed. Usually, the EHR configures the E/M templates in a manner similar to an audit tool, with a section for each of the key components: the chief complaint; HPI; ROS; past, family, and social history (PFSH); exam; and medical decision making (MDM). By working systematically, you and your IT staff can approach the development and customization of these templates in a way that ensures easy use and compliance within the final documentation.

Most EHR programs also have the capability to import documents. Scanning allows you to import a photo image of a document, to be stored in the patient’s chart. Establishing a direct interface between a lab or radiology department to import diagnostic results is a very efficient way to receive medical information into the patient chart. Having a consistent method of importing and cataloging these documents is important because it allows records to be easily identified and located at a later date. To meet compliance and patient care standards, all imported documentation must be reviewed and noted by the ordering physician before being stored in the electronic chart. Take it upon yourself to ensure that this is being done effectively and consistently.

Much of the custom work will be the IT department’s responsibility, with you acting as the compliance consultant. In smaller practice settings, your software vendor can be extremely helpful with the implementation process. Some EHR products offer users groups, which are online chat rooms offering a place for IT people, coders, and practice managers to post questions and discuss known issues. The bigger software companies provide seminars, conferences, and workshops on best-practice concepts and new initiatives. There is also an EHR discussion thread on the AAPC website where coders who are using the same EHR can “meet” and discuss.

Additional EHR Concerns to Address

Who Did What? Most EHRs have some “auditing” capability, where a behind-the-scenes look can identify which employee or clinician entered or edited which pieces of information. This allows you to see who is accessing the medical record (for instance, in case of privacy concerns), who is actually placing orders for medications and diagnostics, and where data entry errors might be occurring (to identify training opportunities). All EHRs should have signature and date recording ability for physicians and performing clinicians to meet the regulatory requirements of a legal medical record. This is one area where you can assist in workflow planning for compliance.

Procedure Templates: Most EHR software allows for easy documentation of office and surgical procedures. Templates should be designed to capture common elements of any given procedure, including anesthesia, informed consent, procedural elements, and follow-up instructions. When using these templates in a test environment, make sure the resulting procedure note makes sense, and your software default choices match the procedure that actually took place. For example, if your provider performs and documents a lesion excision, make sure your resulting note doesn’t document lesion destruction.

Annual Updates: Many of the EHR’s data lists, such as CPT® and ICD-9 codes, can be updated annually by the vendor, but often the vendor can provide only new codes. Frequently, the deleted and revised codes have to be edited individually and manually by you, or someone in IT, to ensure providers do not select invalid or deleted codes. One common issue in an EHR is that old diagnosis codes that are related to previous encounters remain in the patient’s list of chronic conditions, so the invalid codes can inadvertently be chosen again and again to appear on a claim form. Claim edits should be set up to prevent this from happening.

As you move forward with your implementation, other issues may present themselves. It’s critical for documentation compliance that you perform concurrent audits to review the EHR for completeness and accuracy as codes change, software is upgraded, and new providers begin to use the EHR. Having a comprehensive plan for EHR implementation that includes your participation in creating compliant EHR templates is essential. This implementation must include a comprehensive workflow evaluation to ensure that the EHR system your practice is using is configured in the best possible format as a legal medical record.

Pam Brooks, CPC, PCS, is physician services coding supervisor with Wentworth-Douglass Hospital in Dover, N.H.

 

April 4th, 2013

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ICD-10-CM: No Delay This Time

Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), announced there will be no delay to implementation for ICD-10-CM and PCS, which is scheduled October 1, 2014. She then encouraged everyone in the industry to work diligently toward a successful transition.

Tavenner made the statement at the annual Health Information Management Systems Society (HIMSS) conference, a year after she announced a 90-day comment period to determine if and how long a delay would be. The comments at that time ranged from killing ICD-10 completely to making no change from the originally planned date of 2013. Ultimately, the implementation was postponed by a year. Many providers and payers are using the extra year to better prepare.

Several organizations hoped Tavenner might announce another postponement at the HIMSS gathering, and some still advocated shelving the code set, but it looks like implementation is a done deal.

March 21st, 2013

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Top 10 Medicare Risk Adjustment Coding Errors

By Carol Olson, CPC, CPC-H, CPC-I, CEMC, CCS, CCS-P, CCDS

MazeMedicare Advantage (MA) reimbursement can trip you up in ways you didn’t expect. If you are seeing MA patients, be mindful of opportunities and pitfalls.

MA health plans are reimbursed based on beneficiaries’ chronic conditions. Submitting an inaccurate diagnosis, or a diagnosis resulting in a different hierarchical condition category (HCC), is a compliance risk. Any change in the HCC could mean you are receiving too much or too little revenue. Either way, the code would not be validated and would be considered discrepant.

There are opportunities for you to capture a more appropriate HCC code. Consider this list of the top 10 coding errors for risk adjustment:

  1. The record does not contain a legible signature with credential.
  2. The electronic health record (EHR) was unauthenticated (not electronically signed).
  3. The highest degree of specificity was not assigned the most precise ICD-9-CM code to fully explain the narrative description of the symptom or diagnosis in the medical chart.
  4. A discrepancy was found between the diagnosis codes being billed versus the actual written description in the medical record. If the record indicates depression, NOS (311 Depressive disorder, not elsewhere classified), but the diagnosis code written on the encounter document is major depression (296.20 Major depressive affective disorder, single episode, unspecified), these codes do not match; they map to a different HCC category. The diagnosis code and the description should mirror each other.
  5. Documentation does not indicate the diagnoses are being monitored, evaluated, assessed/addressed, or treated (MEAT).
  6. Status of cancer is unclear. Treatment is not documented.
  7. Chronic conditions, such as hepatitis or renal insufficiency, are not documented as chronic.
  8. Lack of specificity (e.g., an unspecified arrhythmia is coded rather than the specific type of arrhythmia).
  9. Chronic conditions or status codes aren’t documented in the medical record at least once per year.
  10. A link or cause relationship is missing for a diabetic complication, or there is a failure to report a mandatory manifestation code.

Regardless of where you find shortcomings in your facility, you should consider ways to improve clinical documentation. Develop a compliance plan and implement prospective and retrospective, internal and external chart reviews with ongoing monitoring and feedback. Be sure to review records based on official coding guidelines.

March 20th, 2013

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Advanced E/M Compliance: Beyond Level-of-service Coding

By Jaci Johnson CPC, CPMA, CEMC, CPC-H, CPC-I

Whether performing an audit or providing education, when it comes to evaluation and management (E/M) coding, your first consideration should be accurate, compliant information and results.

Choose Reliable Resources

Our reliable resources are the Centers for Medicare & Medicaid Services (CMS) 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, the Office of Inspector General (OIG) website for compliance guidance, and the CPT® and ICD-9-CM codebooks for specific coding rules. Medicare administrative contractors (MACs) are also good resources for finding information unique to each geographic area.

Why are these recourses so important? If you choose to educate or audit without these stated rules, you’ll impart your opinions in a very crucial area where there is no place for opinions.

Compliance Supersedes Coding

Audits and education for E/M services should go beyond determining the level of service. Many compliance issues can cause the documentation of an E/M service to fail an auditor’s review. The resources noted above will outline key areas where provider documentation will be at risk for non-compliance, even when the level of service is supported by the documentation. When reviewing E/M documentation, remember the items that make the documentation “complete,” as defined by CMS and the OIG.

Focus on Complete Records

Let’s take a look at the areas that continually threaten the completeness of the medical record:

Relevant History: Each record must state the reason for the encounter, any relevant history, and the exam. The chief complaint must be clearly indicated and the relevant history of the condition(s) that warranted the visit must be documented. In other words, the documented history should have some relationship to the reason why the patient is being seen. Too often the history bears no relevancy on the date of service, and instead reads like a past medical history of many problems not addressed at that visit.

Documentation of the History: The only part of the history that may be documented by a nurse, student, ancillary staff, or the patient is the review of systems (ROS) and/or past, family, and social histories (PFSH). The provider (doctor of medicine (MD), doctor of osteopathy (DO), nurse practitioner (NP), physician assistant (PA), etc.) must document the chief complaint and history of the present illness (HPI).

If someone else documents the ROS or PFSH, there must be a notation supplementing or confirming that the provider reviewed the information. If that confirmation is not a part of the record—even if the patient information supports the level of service—the documentation does not meet the compliance rules, and does not count.

Orders for Diagnostic Tests: If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred. This seems simple enough, and yet it can cause many problems. Compliance issues normally arise in paper records more than in electronic records, where orders for diagnostic tests are often linked to a particular diagnosis.

From a compliance standpoint, an auditor must be able to determine that the provider made the decision to order a diagnostic test. Documentation that supports the order provides data when determining the level of medical decision-making. Without documentation showing the provider ordered the test—and even if the test results are documented—an auditor may infer that ancillary staff ordered the test.

Signatures: Per CMS, a signature is “a mark or sign by an individual on a document to signify knowledge, approval, acceptance, or obligation.” This statement does not indicate the signature must be a complete name. In the event of an audit, a provider may provide a signature log to reflect the signature with a typed name. In the instance where a medical record is submitted without a signature, an attestation can be submitted as proof that the provider saw the Medicare beneficiary on that date of service.

Signatures are crucial to validate who saw and participated in the care of the patient. Regardless of the caregiver (e.g., nurse, medical assistant (MA), certified medical assistant (CMA), NP, MD), there must be a signature showing this health professional documented an encounter in the patient’s medical record. Auditors look carefully at who is signing notes and how the notes are signed, which can provide insight into noncompliant practices. Signatures (or the lack of signatures) can reflect who is performing services, versus who is supposed to be performing services.

A good resource for additional signature guidance is your MAC.

Participation of Medical Students: This often comes up in an E/M audit, and goes back to who is allowed to document and perform certain parts of the patient encounter. A medical student may document only the ROS or PFSH, and the provider must confirm that information. Because this is a teaching situation and the student may be asked to take a history and/or perform an exam, as well as document his or her findings, it’s important to understand how that documentation can be used, if at all. The teaching physician must re-perform and re-document his or her own history and exam. Only the work and documentation of the teaching physician will be used for determining the level of service.

Make Sure Guidelines Are Met

When auditing or educating for E/M services, it is crucial to look beyond the level of service to determe if guidelines have been met. Much goes into determining if the medical record is complete. Read the tools and resources and consider each encounter note carefully to determine if the documentation can withstand both coding and compliance audits.

Jaci Johnson, CPC, CPC-H, CEMC, CPMA, CPC-I, is president of Practice Integrity, LLC. She has worked in medical coding and auditing for 24 years and has been a Certified Professional Coder (CPC®) since 1994. Ms. Johnson has expertise in coding for family practice, urgent care, OB/GYN, general surgery, and Medicare’s Teaching Physician Guidelines, with a particular emphasis on E/M guideline compliance. She serves on the AAPC National Advisory Board (NAB), and is past president of her AAPC local chapter. She was also recognized as Virginia’s 2006 Coder of the Year.

November 1st, 2012

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Fractures 101: Let’s Cover the Basics

By Cynthia Everlith, BSHA, CPC, CMA

Fracture care may seem straightforward, but there are common misconceptions and confusion when it comes to the different types of fractures and how to bill for services. To set the record straight, here’s everything you wanted to know about fractures, but were afraid to ask.

What Is a Fracture? 

Many people believe a fracture is a “hairline break,” or a certain type of broken bone. That is not true: A fracture and a broken bone are the same thing.

What Are the Different Kinds of Fractures?

There are several types of fractures: transverse, oblique, spiral, angulated, displaced, and angulated, and displaced (see Figure 1).

How Many Types of Fractures Are There?

An exhaustive list of precise fracture types would fill a book. A few examples include the following:

Barton’s fracture: Fracture of the distal end of the radius into the wrist joint (ICD-9-CM 813.42 Other closed fractures of distal end of radius (alone)).

Fissure fracture: A crack extending from a surface into, but not through, a long bone.

Jefferson’s fracture: Fracture of the atlas (first cervical vertebra).

Lead pipe fracture: The bone cortex is slightly compressed and bulged on one side, with a slight crack on the other side of the bone.

Parry fracture/Monteggia’s fracture: Fracture of the proximal half of the shaft of the ulna, with dislocation of the head of the radius (ICD-9-CM 813.03 Closed Monteggia’s fracture).

Ping-pong fracture: A type of depressed skull fracture usually seen in young children, resembling the indentation that can be produced with the finger into a ping-pong ball; when elevated it resumes and retains its normal position.

Pott’s fracture: Fracture of the lower part of the fibula, with serious injury of the lower tibial articulation, usually including chipping of the medial malleolus, or rupture of the medial ligament.

Colles’ fracture: A fracture of the lower end of the radius, with the lower fragment displaced backward. If the lower fragment is displaced forward, it is a reverse Colles’ fracture (ICD-9-CM 813.41 Closed Colles’ fracture).

These are just a few fracture types; the list is extensive. To help with coding when reviewing fracture documentation, have a medical dictionary or other resource on hand to look up unfamiliar terms.

How Do You Fix Fractures? 

Generally, bones heal best when immobilized, so treatment often involves casting the broken bone (or fracture), and may require surgery to set the bone in place. Prior to casting or fixation, the broken bone(s) must be returned to its proper position. This is referred to as “reduction.”

“Closed” reduction is manipulation of a fracture without an incision. “Open” reduction refers to manipulation of a fracture after incision into the fracture site. When coding fractures, you will need to know the type of reduction used, as well as which body part is affected (leg, arm, finger, foot, etc.) and, in some instances, the precise location of the fracture (For instance, does the fracture affect the head or shaft of the femur?).

As an example, consider the X-ray images in Figure 2. Each describes a different type of fracture and fracture reduction.

The X-ray on the left reveals a fracture on the third or long finger proximal phalanx (816.01 Closed fracture of middle or proximal phalanx or phalanges of hand). This fracture is minimally displaced, and could be an example of a closed treatment of a phalangeal fracture (CPT® 26720 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each) or closed treatment with manipulation (26725 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each), depending on what the provider documents.

On film A, the short arrow shows a displaced fracture of the index finger (816.01), while the long arrow shows multiple finger metacarpal fractures (815.03 Closed fracture of shaft of metacarpal bone(s)).

On Film B, the short arrow points to a percutaneous pin fixation (CPT® 26727 Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each) and the long arrow points to an internal fixation with plates and screws (CPT® 26615 Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone). There are also types of internal fixation for fractures, such as rods and spheres.

How Do You Bill Fracture Fees?

There are two common approaches when coding non-manipulative fracture care services. The American Academy of Orthopaedic Surgeons (AAOS) and the American Medical Association (AMA) support these two approaches. The AMA has published several articles in CPT® Assistant to reflect how these options work. The two options are:

  1. Fracture global fees
  2. Alternative method for fracture fees

The AAOS Guide to CPT® Coding for Orthopaedic Surgery definition of fracture global fees reporting method states:

“Fracture global fees may include the hospital or office encounter in some payment areas. In others, CMS allows you to code an E/M service with a -57 modifier [Decision for surgery] within the global period if the visit was the one in which the decision to perform the procedure was made. The initial cast or splint is applied, and all revisits, excluding radiographs that are obtained by the physician, should be included within a 90-day period from the time of the initial fracture. All recastings and or splinting are on an ‘encounter’ basis and are separately billed.”

AAOS defines the alternative method as such:

“Only when treatment of the fracture does not consist primarily of a ‘procedure’ (for example, closed treatment without manipulation), services may be itemized as if the problem were recognized as an office encounter. Examples include an undisplaced fracture of the fifth metatarsal; a fracture of the pelvis, undisplaced or minimally displaced; or a compression fracture of a vertebra. Office, hospital, and emergency department encounters are coded as appropriate, as are all injections, supplies, casts, splints or treatment program necessities.”

Be aware that this guidance is payer specific: When fracture care is performed in the office, the payer may want you to append modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service to the evaluation and management (E/M) service.

Your practice must decide whether to bill for treatment of a fracture or to itemize, depending on your scenario.

Coding Example No. 1

Closed reduction without manipulation vs. E/M

If you report closed reduction w/o manipulation:

  • Cast/splint/strapping is included.
  • X-ray and supplies may be separately reported.

If you report an E/M service:

  • Cast/splint application, X-ray, and supplies all may be separately reported.

The closed reduction, if you report it, includes a 90-day global package. The first casting, splinting, and strapping are included in the procedure, along with all post-op visits. Global treatment excludes X-rays, durable medical equipment (DME), and any casting or splinting supplies, all of which must be reported separately. The global package means that you are not allowed to charge for the post-operative portion of the procedure. In simple terms, you cannot charge for an office visit until after the global period.

In such a case, proper coding would be:

  • Procedure: 26725
  • Do not code separately for cast or splint application.
  • Next visit: 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure
  • You cannot charge separately for related E/M services during the 90-day global period.
  • You may report casting and/or splinting supply charges according to documentation.

Coding Example No. 2

A patient comes into your office with a fractured clavicle. The fracture is not displaced and has good position. The patient is given a sling and told to follow up PRN (as needed). Can the office bill fracture care? Is this considered treatment if the patient is not to return?

Remember: When charging for a fracture care code (or any surgical procedure), there is a formula that includes preoperative, operative, and postoperative portions.

Physician reimbursement (approximate): 

  • 17 percent preoperative
  • 63 percent operative
  • 20 percent postoperative

In this example, there is no intent that the provider will follow up with the patient, which eliminates the postoperative portion of the formula. The argument could be made that billing the fracture treatment code would be incorrect. For instance, if an emergency department (ED) physician treats a fracture with no intent to follow up with the patient, it would be incorrect to bill a fracture care code. Rather, you would report an appropriate E/M service.

Let’s consider a different scenario using fracture codes and how the reimbursement varies using the formula.

Coding Example No. 3

A patient was injured on the slopes of Utah and lives in New Jersey. He has surgery in Utah and returns home, where he receives follow-up care. What happens to reimbursement?

Ideally, the surgeon in Utah should get 17 percent for the preoperative portion and 63 percent for the operative or surgical portion. If the surgeon knows that the patient is not staying for postop care, he should apply modifier 54 Surgical care only to the billed fracture care code. He or she should call (and provide written documentation to) the patient’s orthopedist in New Jersey to transfer care. The orthopedist accepting care should bill the same surgery code with modifier 55 Postoperative care. The accepting orthopedist would receive 20 percent or the postoperative fee.

In the real world, the billing is almost never as ideal as in our examples. What surgeon wants to give up 20 percent of his surgery fee? What physician wants 20 percent payment to treat someone else’s work? In working in orthopedics for 25 years, I have not seen this happen. What can one do if faced with this similar scenario?

You should make a call to the surgeon in Utah (or wherever the initial treatment occurred) and plead your case. If the surgeon has already filed a claim, but agrees to split the fee, a corrected claim would need to be filed. If there is no phone call placed, with no documentation stating the transfer, you cannot bill for the postoperative care.

Cynthia Everlith, BSHA, CPC, CMA, is practice administrator for Arizona Hand and Wrist Specialists, a division of OSNA, PLLC. She has more than 25 years of experience in orthopaedic coding and practice management, and 16 years with her current practice. She is actively involved in workers’ compensation legislation and has worked closely with the Industrial Commission of Arizona and the Arizona Medical Association in rules affecting physicians. She has presented nationally and locally. She is a past American Association of Orthopaedic Executives (AAOE) Board of Directors and past president of AAPC’s Grand Canyon Coders Phoenix chapter. She serves on the AAOE Communication Council and Technology Task Force, and is president of the Arizona AAOE Chapter.

October 1st, 2012

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