CPT 2011: Overview of Major Code Changes

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CPT 2011: Overview of Major Code Changes2

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CPT 2011: Overview of Major Code Changes 3

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Thank you for participating in our “CPT 2011: Overview of Major Code Changes” audio conference, featuring speakers Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and moderated by Michelle Leppert, CPC-A.

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4 CPT 2011: Overview of Major Code Changes

5 Agenda

6 Speaker profiles

7 Exhibit APresentation by Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I

51 Exhibit BList of useful industry acronyms

56 Resources

CONTENTS

CPT 2011: Overview of Major Code Changes 5

AGENDA

I. Overview of changes

II. Overview of evaluation & management changes

III. Critical care

IV. Overview of changes to surgery section

V. Overview of changes to respiratory section

VI. Overview of changes to cardiology section

VII. Overview of changes to medicine section

VIII. Overview of changes to digestive section

IX. Overview of changes to urinary section

X. Overview of changes to nervous section

XI. Overview of changes to radiology section

XII. Overview of changes to pathology and laboratory section

XIII. Overview of category II code changes

XIV. Overview of category III changes

XV. Live Q&A

CPT 2011: Overview of Major Code Changes6

Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP

Jillian Harrington is president and CEO of ComplyCode, a healthcare compliance consulting

firm in Binghamton, NY, and has more than 16 years of experience in the healthcare profession. She is the former chief compliance officer and chief privacy official of a large academic medical center, and also has extensive background in both the professional and technical components of CPT/HCPCS and ICD-9-CM coding.

Jennifer Avery, CCS, CPC-H, CPC, CPC-I

Jennifer Avery is a senior regu-latory specialist with HCPro, Inc., and a lead instructor for the company’s Certified Coder Boot

Camp®—Original Version (covers physician and outpatient hospital coding) as well as the Certified Coder Boot Camp—Inpatient Version (inpatient hospital facility coding). She has extensive experi-ence as both inpatient and outpatient coder for physicians and facilities.

SPEAKER PROFILES

7

Presentation by Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I

Current Procedural Terminology (CPT) is Copyright © 2010 American Medical Association (AMA). All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

EXHIBIT A

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51

List of useful industry acronyms

Source: HCPro, Inc.

EXHIBIT B

52

Exhibit B

CPT 2011: Overview of Major Code Changes

AAPC American Academy of Professional CodersABN Advance beneficiary noticeACDIS Association of Clinical Document Improvement SpecialistsADR Additional documentation requestAHA American Hospital AssociationAHIMA American Health Information Management AssociationAHRQ Agency for Healthcare Research and QualityAMI Acute myocardial infarctionAOA American Osteopathic AssociationAPCs Ambulatory payment classificationsARRA American Recovery and Reinvestment Act of 2009ASC Ambulatory surgery centerASP Average sales priceAWP Average wholesale price

CAH Critical access hospitalCC Complication or comorbidityCCHIT Certification Commission for Health Information TechnologyCCR Continuity of care record/Cost-to-charge ratioCDI Clinical documentation improvementCDM Charge description masterCERT Comprehensive Error Rate TestingCPI Consumer price indexCMI Case-mix indexCMS Centers for Medicare & Medicaid ServicesCMSA Consolidated Metropolitan Statistical AreaCOBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99-272CPI Consumer price indexCPT Current procedural terminologyCRNA Certified registered nurse anesthetistCT Computed tomographyCY Calendar year

DED Dedicated emergency departmentDRA Deficit Reduction Act of 2005, Pub. L. 109-171DRG Diagnosis-related groupDSH Disproportionate share hospital

ED Emergency departmentEDMS Electronic Document Management SystemEHR Electronic health record

53

Exhibit B

CPT 2011: Overview of Major Code Changes

E/M Evaluation and managementEMR Electronic medical recordEMTALA Emergency Medical Treatment and Active Labor Act of 1986, Pub. L. 99-272EOB Explanation of benefitsePHI Electronic protected health information

FDA U.S. Food and Drug AdministrationFFY Federal fiscal yearFI Fiscal intermediaryFY Fiscal year

GAF Geographic adjustment factorGME Graduate medical education

H&P History and physicalHAC Hospital-acquired conditionHCFA Health Care Financing AdministrationHCPCS Healthcare Common Procedure Coding SystemHCRIS Hospital Cost Report Information SystemHHA Home health agencyHHS U.S. Department of Health and Human ServicesHIC Health insurance cardHIMSS Health Information Management Systems SocietyHINN Hospital-Issued Notice of Non-CoverageHIPAA Health Insurance Portability and Accountability Act of 1996HIS Health information system/servicesHIT Health information technologyHITECH Act Health Information Technology for Economic and Clinical Health ActHMO Health maintenance organizationHSA Health savings accountHSRVcc Hospital-specific relative value cost centerHQA Hospital Quality AllianceHQI Hospital quality initiative

ICD-9-CM International Classification of Diseases, 9th Revision, Clinical ModificationICD-10-PCS International Classification of Diseases, 10th Edition, Procedure Coding SystemICU Intensive care unitIHS Indian Health ServiceIOM Institute of MedicineIPF Inpatient psychiatric facilityIPPS Inpatient prospective payment systemIRF Inpatient rehabilitation facility

54

Exhibit B

CPT 2011: Overview of Major Code Changes

IT Information technology

JCAHO Joint Commission on Accreditation of Healthcare Organizations

LCD Local coverage determinationLTC-DRG Long-term care diagnosis-related groupLTCH Long-term care hospital

MAC Medicare administrative contractorMCC Major complication or comorbidityMCO Managed care organizationMCV Major cardiovascular conditionMDC Major diagnostic categoryMDH Medicare-dependent, small rural hospitalMedPAC Medicare Payment Advisory CommissionMedPAR Medicare Provider Analysis and Review FileMIC Medicaid Integrity ContractorsMMA Medicare Prescription Drug, Improvement and Modernization Act of 2003, Pub. L. 108-173MRHFP Medicare Rural Hospital Flexibility ProgramMS-DRG Medicare Severity DRG

NAHIT National Alliance for Health Information TechnologyNCCI National Correct Coding InitiativeNCD National coverage determinationNCHS National Center for Health StatisticsNCQA National Committee for Quality AssuranceNCVHS National Committee on Vital and Health StatisticsNHIN National Health Information NetworkNICU Neonatal intensive care unitNPI National Provider IdentifierNQF National Quality ForumNVHRI National Voluntary Hospital Reporting Initiative

OCE Outpatient code editorOCR Office for Civil RightsOES Occupational employment statisticsOIG Office of Inspector GeneralOMB Executive Office of Management and BudgetOPPS Outpatient prospective payment systemOR Operating roomOSCAR Online Survey Certification and Reporting (System)

55

Exhibit B

CPT 2011: Overview of Major Code Changes

PHR Personal health recordPO By mouthPOA Present on admissionPPI Producer price indexPPS Prospective payment systemPRA Per resident amountPRM Provider Reimbursement ManualPRRB Provider Reimbursement Review BoardPS&R Provider Statistical and Reimbursement (System)

QIO Quality Improvement Organization

RA Remittance adviceRAC Recovery audit contractorRBC Red blood cellRC Revenue codeRHC Rural health clinicRHIO Regional health information organizationROI Release of information (OR return on investment)RY Rate year

SAF Standard analytic fileSCH Sole community hospitalSNF Skilled nursing facilitySOCs Standard occupational classificationsSSA Social Security AdministrationSSI Supplemental Security IncomeST Status indicator

TAG Technical Advisory Group

UHDDS Uniform Hospital Discharge Data Set

WBC White blood cell

ZPIC Zone Program Integrity Contractor

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Speaker contact information

Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHPPresident and CEOComplyCode Resource Management57 Woodlawn DriveBinghamton, NY 13904Phone: 607/427-1092E-mail: jharrington@complycode.com

Jennifer Avery, CCS, CPC-H, CPC, CPC-I HCPro, Inc.200 Hoods LaneMarblehead, MA 01945Website: www.hcpro.com

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